2026 Born to Excel Camp

2026 Born to Excel Camp

Born to Excel Camp 2026

Monday, June 22 - Friday, June 26 - 9 a.m. until 12 noon
Crossroads Church of Lillington 1301 S Main St, Lillington, NC 27546 ~ 910-893-9754
Camp Options and IMPORTANT Registration Information:
- Campers entering 1st-8th grades in the Fall of 2026 should sign up for two classes, according to their grade level.
- High School Students only register for the High School Class.
- The Cooking class and snack time involve food. If your child has food allergies, please let us know.
- Preschool classes are only available for children of parents and grandparents who are camp volunteers. DO NOT sign your preschool/kindergarten child up for an elective class. Preschoolers must be potty trained.
- Questions? Please email borntoexcel@crossrdschurch.com
Information
Primary Parent/Guardian
Parent/Guardian*

First NameLast Name
Relationship*
If other, please define.
E-mail*
Mobile*

Area CodePhone Number
Work

Area CodePhone Number
Home

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Secondary Parent/Guardian
Parent/Guardian

First NameLast Name
Relationship
If other, please define.
E-mail
Contact Number/Mobile

Area CodePhone Number
Work

Area CodePhone Number
Authorization for Camper(s) pick-up, other than those listed above:

If there is the slightest possibility that you will not be able to pick up your child, please complete this section.
Authorized

First NameLast Name
Phone Number

Area CodePhone Number
Authorized

First NameLast Name
Phone Number

Area CodePhone Number
Individuals NOT PERMITTED to pick up Camper(s), if applicable:
Not Permitted to Pick-Up
Not Permitted to Pick-Up
Medical Information

In the interest of the health of campers as well as staff, please evaluate your child's/children's health each morning prior to bringing them to Crossroads Church. If they exhibit cold or flu symptoms, please keep them at home. If they arrive at Camp with sneezing, coughing, runny nose, and/or fever, we will request that you take them home.
Health Insurance Carrier *
Policy # *
Group # *
Policy holder's name and relationship to child *
Family Doctor *
Doctor's Phone Number *
Emergency Contact*
Relationship to Child*
Phone Number*
REGISTER EACH CHILD INDIVIDUALLY.

To allow us to monitor attendance and availability accurately, please complete one form per child.
Camper
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Gender*
T-shirt Size *
Grade (Fall 2026)*
YesNo
Camper Class Options

Classes are only available for grades 1 through 8. Choose 1 per class period. Preschool/nursery is only available for volunteers.
Preschool
High School (9th-12th graders only)
Class 1 (1st-8th graders only)
Class 2 (1st-8th graders only)
Does Camper have:
AllergiesFood allergiesAsthmaHeart conditionDiabetesHeadachesSeizuresFaintingFrequent upset stomachOtherNone of the above
Please explain any checked boxes above
Have sight or hearing impairmentsWear hearing aidsWear contact lensesHave any condition that would prevent him/her from participating in any of the activities of this programOther, please add details belowNone of the above
Please explain any checked boxes above
Does Camper:
Does camper take prescription medication?*
Will camper be taking medication during camp hours?*
If yes, please list prescription medication to be taken
Additional notes
- I, the undersigned parent or guardian, hereby consent to my child/children participating in Born To Excel Summer Camp, an event sponsored by Crossroads Church of Lillington. I certify that my child/children is/are able to participate in all activities. If my child/children has/have medical conditions which may be relevant to a physician in the event of an emergency, I have listed them in the Emergency Medical Information section. In the event an emergency occurs, and I cannot be reached, I hereby authorize Crossroads Church of Lillington to make emergency medical decisions for my child/children. If there are any activities I do not want my child/children to be involved in, I have listed them.
  
  I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED IN ASSOCIATION WITH SAID ACTIVITY, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO.
  
  I do hereby agree to hold Crossroads Church of Lillington and its agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child/children, even injury resulting in death, or property which I now have or which may arise in the future in connection with the activity or participation in any other associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the law of the State of North Carolina and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital.
  
  I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS OF AND SIGN THE RELEASE AS MY OWN FREE ACT.
  
  I acknowledege that this is a legally binding agreement which I have read and understand.
- I DO give permission for pictures of my child/children to be posted on Crossroads Church of Lillington's social media sites and in a daily Camp newsletter for parents.I DO NOT give permission for pictures of my child/children to be posted on Crossroads Church of Lillington's social media sites and in a daily Camp newsletter for parents.
- Yes, we are involved at Crossroads Church of Lillington.No, we are not currently involved in a local church.Yes, we are involved with a local church in the area.
- Parent/Guardian Electronic Signature (please enter name)*
- Payment: Cost is $40 per camper
  
  Please consider offering a scholarship for a camper who would not otherwise be able to attend due to financial hardship.
- My Products
  prevnext( X )
  Payment is $40.00 per Camper$40.00
  2026 Born to Excel Camp
  
  Quantity
  
  Scholarship for another camper$40.00
  Scholarship for another camper
  
  Total $0.00
- Should be Empty: