HC KIDS CAMP '26

Institution Name

STUDENT INFORMATION

Name

First NameLast Name

M.I.

Birth Date

Date

Gender

Grade Promoted to:

Home Church (if any)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.

Primary Guardian

First NameLast Name

Relationship to child

Phone Number

Format: (000) 000-0000.

Alternate Guardian

First NameLast Name

Relationship to child

Phone Number

Format: (000) 000-0000.

Medical Information

Please list all allergies -- or type "none" if there are none

Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)

Please list all medical concerns -- or type "none" if there are none

Additional Information

Photos/videos are taken for promotional purposes related to Hope City Church and HC Kids Camp. These pictures appear in various media outlets such as our social pages and website. Do you allow your child to be included in these photos/videos?

By submitting this form, I ackowledge that I have read and understand the above information. I also hereby release, discharge, and hold harmless Hope City Church, its pastors, staff, and volunteers from any and all claims, demands, or causes of action arising from accidental injury, illness, or property damage during HC Kids Camp.

Signature