2026 Kids Camp-In Registration Form

Permissions
These additional individuals are authorized to pick up this child(ren) from SHBC ministries or events. (In addition to parents and the Secondary Emergency Contact)
Name
Relationship
Name
Relationship
Are there any persons not allowed to have contact with, or pick up, your child(ren)? *** If yes, please contact Spring Hills Safety & Security Director, Marvin Rutter, to provide necessary information 740-403-1819
Date

MonthDayYear
Date
Please Print

First NameLast Name
Signature
Preferred Physician
Physician Phone Number
Format: 000-000-0000.
OR in the event the appropriate specified practitioner is not available, by another licenced physician or dentists:

2. The transfer of minor to preferred hospital or any hospital reasonably accessible.
Preferred Hospital
3. This authorization does not cover major surgery unless the medical opinions of two other licensed physicans or dentists concurring in the necessity for such surgery are obtained in writing prior to the performance of such surgery.
I AGREE
Initial Here
Date

MonthDayYear
Date
Please Print

First NameLast Name
Signature

Camp Fee$125.00

Please make sure to select the number of children/students you are registering for this event

Number of Students

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Kids Camp-In 2026 - Child/Student Registration Form