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*

Non-SwimmerBeginner Swimmer (can swim on front 20ft without flotation)Advanced Swimmer (can pass swim test)
Bunk request. Each camper may request no more than two bunkmates. Camp Agape does not guarantee bunkmates, this is only a request.

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name*
Or enter N/A if not applicable
Parent's Work/School Phone
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone
Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Home Phone
Home Address Same as Parent/Guardian 1?

Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work Name
Or enter N/A if not applicable
Parent's Work Phone
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone

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*
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*
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: