2026 Back To School Readiness Bootcamp Registration

Child's Name

First NameLast Name

Child's Birthdate

Gender

Child's Current Grade for School year of 2026 - 2027

Child's Allergies, Chronic Illnesses, and Medical Conditions: Please list and describe any allergies, chronic illnesses, or medical conditions your child may have. Medication Administration: BOOT CAMP STAFF DOES NOT ADMINISTER MEDICATIONS If your child needs to take medication during BTSR Boot Camp hours, it is your responsibility as a parent to ensure that all medications that your child needs are administered. Please provide the name(s) of who will be responsible for administering the medication and the name of the medication. Note: Back-to-School Readiness Boot Camp Staff will not administer medication.

ParentLegal Guardian(s) Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

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

Cell Number

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

1st Emergency Contact

2nd Emergency Contact (needs to be different from 1st Emergency contact)

Church Affiliation

How did you hear about CBWC "Back to School Readiness Bootcamp?"

Please choose your child's Mode of Transportation to and from BTSCR Bootcamp (please note that Bootcamp dismissal is at 2:45 pm daily)

CBWC Back to School Readiness Bootcamp Discipline Policy will be provided on the 1st day of Camp. Please make sure you receive a copy and review the information with your child(ren).

Informed Consent/Authorization and Acknowledgement:

I, parent(s)/legal guardian hereby give my approval for my child’s participation in any and all activities prepared by Cincinnati Bible Way Church Back to School Readiness Bootcamp during the week of July 27th thru July 31st, 2026, selected camp (CBWC BTSRBC). In exchange for the participation of said child by CBWC BTSRBC, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Cincinnati Bible Way Church, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury or injury resulting in death to said child, I hereby waive all claims against Cincinnati Bible Way Church including all instructors, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the Cincinnati Bible Way Church Back to School Readiness Bootcamp now or which may arise in the future.

The CBWC BTSRBC will be taking walking field trips; outside recess times; participating in the visits from the Cinti. Museum Center and Madisonville Library. As part of participating in BTSRBC the child will need to ride the bus to "The Place" Skating Rink at 3211 Lina Place (39) and I agree to my child attending "The Place" Skating Rink and to being transported to and from Cincinnati Bible Way Church. Understanding this, I give my permission for my child to participate in all activities.

In the event of emergency medical health care, I, hereby authorize that as the parent(s)/legal guardian of the above name child, I give consent to any acts which may be necessary or proper to provide medical care, administration of medical care and transportation for medical treatment, determined by a physician or paramedic to the above name child if necessary for the welfare of my child while said child is under the care and attending the Cincinnati Bible Way Church Back to School Readiness Bootcamp. I shall immediately be notified if medical care is being provided on behalf of above-named child.

This consent/authorization form shall be effective from July 27th until July 31st, 2026. I have carefully read the foregoing release and fully understand the contents thereof, and I sign this release of my own free will.

PHOTO/VIDEO RELEASE FORM I hereby give permission for images of my child (ren) captured during Cincinnati Bible Way Church Back to School Readiness Boot Camp through video, photo, and digital camera and any reproduction or adaptations of the images for fund raising, publicity, or other purposes to help achieve the group’s aims. This might include (but not limited to) the right to use them in their printed and on-line publicity, social media, press releases and funding applications. I waive any rights of compensation or ownership thereto and give permission to the PHOTO/VIDEO Release.

During our visit to "The Place" Skating Rink, all youth participants will be required to wear a BTSRBC T-shirt. The shirt will be provided for the child (ren) at no cost to parent or legal guardian. In addition, it is a must that your child (ren) wear gym shoes and socks for the skating event. There will be multiple attractions at the venue your child (ren) will be able to participate in, such as Laser Tag, Bumper Cars, Climbing Walls, etc. and that requires them to wear gym shoes and socks. To ensure the correct fit, please provide the size T-shirt for the child named above.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

BACK TO SCHOOL READINESS BOOT CAMP REGISTRATION

CHILD'S INFORMATION

PARENTAL/LEGAL GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

INFORMED CONSENT AND ACKNOWLEDGEMENT