Kids Church Camp Registration 🏕️
Share your child’s details, emergency/medical needs, and pickup authorization to register.
Child’s Full Name
*
First Name
Last Name
Child’s Age
*
Child’s Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Parent/Guardian Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Relationship to Child (Emergency Contact)
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies, Medical Conditions, Dietary Restrictions, or Other Needs?
*
No
Yes—Please explain
Please explain any allergies, medical conditions, dietary restrictions, or other needs.
*
Anything else that would help our staff care for your child?
Who is authorized to pick up your child?
*
Photo Permission
*
YES, I give permission for my child to be photographed/videoed.
NO, I do not give permission for my child to be photographed/videoed.
Parent/Guardian Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Register
Register
Should be Empty: