The 4 Lessons Superhero Enrichment Camp Registration Form

The 4 Lessons Superhero Enrichment Camp Registration Form

Please complete this form to register your child for the summer camp, including parent and emergency contact details, attendance, and permissions.
Parent / Guardian Information
Parent/Guardian Full Name

First NameMiddle NameLast Name
Relationship to Child
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Youth Participant Information
Child’s Full Name

First NameLast Name
Child’s Age
Child’s Grade Level
Child’s School
Allergies, Medical Conditions, Dietary Restrictions, Learning Needs, Behavioral Needs, or Special Accommodations
Current Medication Staff Should Be Aware Of
Emergency Contact
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Relationship to Child
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Attendance and Meals
Which day(s) will your child attend?
Will your child participate in the meal times provided through the church feeding ministry?
Will a parent, caregiver, or adult family member participate in selected family enrichment conversations?
Pickup Authorization
Who is authorized to pick up your child?
Is there anyone who is not authorized to pick up your child?
Permissions and Acknowledgments
Program Participation Permission
Meal Acknowledgment
Liability Acknowledgment
Emergency Medical Authorization
Photo / Video Permission
Future Program Updates
Signature
Parent/Guardian Electronic Signature
Date

MonthDayYear
Date
Should be Empty:

The 4 Lessons Superhero Enrichment Camp Registration Form

Parent / Guardian Information

Youth Participant Information

Emergency Contact

Attendance and Meals

Pickup Authorization

Permissions and Acknowledgments

Signature