Clone of 2025 Camper Registration Form

Camper Registration Form

These forms are required for your children to attend camp.
Camper's Information
Camper Name
Nickname
Gender
Birthdate

MonthDayYear
Date
NOTE - Children need to have completed 2nd grade or be 8 years old by August 1, 2026 before they are eligible to participate in kid's camp. Youth camp participants must have completed 6th grade.
T-Shirt Size
Entering Grade in August 2026
Church/Group
Camper Swimming Ability
Bunk request. Each camper may request no more than two bunkmates. Camp Agape does not guarantee bunkmates, this is only a request.

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact #1
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Format: (000) 000-0000.
Relationship to Child
Emergency Contact #2
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Format: (000) 000-0000.
Relationship to Child

Payment and Statement of Understanding
Camp Agape, Woodland Lakes, and/or Love City Church have permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.
Type first and last name above to consent
Acknowledgement of Policies and Procedures I have reviewed and received a copy of the center's policies and procedures/handbook.
Type first and last name above to consent
I understand and acknowledge that my camper will not be permitted to have cell phone while on campus. The office phone number and director's number will be made available to me for emergency contact.
Type first and last name above to consent
Sign Document
Date Signed

MonthDayYear
Should be Empty: