Clone of 2025 Summer Camp Registration

Registration Form

Welcome! We look forward to meeting you & your camper this summer. Slots are limited; BOTH the registration form and registration fee are required to secure your spot. Blessings!
Member ID
Camper Name
Nickname
Date of Birth

MonthDayYear
Age
NOTE - Children need to be age 5 - 14 (Kindergarten - 8th Grade) to be eligible to participate in our summer camp. There is a $75 registration fee per child.
Which camp are you registering for?
Entering This Grade in the Upcoming School Year
School Camper Attends
How Did You Hear About Camp T.H.R.I.V.E!
T-Shirt Size
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.

This is a fill in the blanks field. Please add appropriate blank fields and text.
Parents' Information

Parent/Guardian 1
Parent/Guardian 1

First NameLast Name
Relationship to Child
E-mail
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
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
Format: (000) 000-0000.
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would you like to be reached while your child is at camp?
Parent's Information

Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Home Address Same as Parent/Guardian 1?
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
Format: (000) 000-0000.
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would parent/guardian 2 like to be reached while your child is at camp?

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least two persons 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

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.
Secondary Phone Number
Format: (000) 000-0000.
Relationship to Child
Emergency Contact

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.
Secondary Phone Number
Format: (000) 000-0000.
Relationship to Child

Parental Agreements

Please check each disclaimer.
Check each box signifying acceptance, understanding, and compliance.

I understand that THRIVE Christian Academy (TCA) and Camp THRIVE do not provide insurance to cover any child who may sustain any injury while participating in this program. If my child should become ill or injured during any activity, I understand that the recreation staff will: 1) Attempt to contact me immediately using the information provided OR 2) Attempt to contact the person I have designated under emergency contacts (if I cannot be reached). If I or the person designated is unable to be reached, T.H.R.I.V.E. Christian Academy, Inc. is authorized to arrange for immediate emergency treatment necessary to ensure the health and safety of my child.I understand that TCA and Camp THRIVE cannot accommodate children who exhibit aggressive or disrespectful behavior. Children who are unruly or present a disciplinary problem may be dismissed from the program to ensure the safety of all. I understand that if my child’s behavior presents a problem, he/she may be expelled from the camp program in its entirety at the sole discretion of the administrator. No refunds will be given.I indemnify TCA and Camp THRIVE, and understand that TCA and Camp THRIVE pledge to provide a high quality and recreation system that offers opportunity for play, learning, teamwork and personal growth. TCA and Camp THRIVE programs and facilities are offered to all persons regardless of race, color, sex, national origin, age, creed or ability. All athletic and recreational activities involve some risk of accident or injury. TCA and Camp THRIVE do not provide insurance, nor does it assume responsibility for such accidents or injuries. Your participation in this program and the use of its equipment is at your own risk. Photos and videos will be taken of participants for departmental marketing and advertisement purposes only.

Payment and Statement of Understanding
TCA has 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
This form, after being completed and submitted by the parent/guardian, must be reviewed for completeness and signed by the administrator/designee prior to the child receiving care. After the child is attending the program the administrator shall have the parent/guardian review and initial the form when any changes/updates are made and at least annually. The parent/ guardian and the administrator or designee shall initial and date the form in the section below to indicate when the form was last reviewed.
Type first and last name above to consent
Acknowledgement of Policies and Procedures - a copy of the center's policies and procedures/handbook is available online and/or by request.
Sign Document
Date Signed

MonthDayYear
Camp Director Name and Contact Info

My Products

Registration Fee (All Ages)$75.00

Quantity

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Total $0.00

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Registration Form

Parents' Information

Parent's Information

Emergency Contacts/Authorized Pickup

Emergency Contact

Emergency Contact

Medical / Health Information

Additional Medication

Parental Agreements

Payment and Statement of Understanding

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