Camp Chaos

Parents Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

How many kids will be attending?*

Child #1

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #2

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #3

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #4

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #5

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #6

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #7

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #8

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #9

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*

Child #10

First NameLast Name

Age*

Grade (if applicable)

Grades 9th-12th are welcome to attend as Jr Workers

Allergies?*

What type of allergies?*

May we have permission to use photos or videos of your child for church-related purposes, including but not limited to our website and social media (Facebook, Instagram, TikTok, Twitter/X)?*