Exmore Baptist Church Camp Discovery Registration

Exmore Baptist Church Camp Discovery Registration

LAVA LAVA LUAU
Camp Discovery is a 3 day camp for children who have completed the 1st grade - 5th grade and is designed to bring Bible Stories and exciting games together.
Camp runs from 9:00 am - 5:00 pm

(Doors will open at 8:45 AM)
Camper Name

First Name Last Name
Birthdate

Month Day Year
Date
Grade - Just Completed
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Infomation

First Name Last Name
Phone Number

Area Code Phone Number
Cell Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
Email
example@example.com
Insurance Company
Policy Number
Emergency Contact

First Name Last Name
Relationship
Phone Number

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
T-Shirt Size - Sizes are Kids Sizes - if Adult Sizes are needed please notify us.

	Number Size	Chest	Length
XS	6-8	16	20 1/2
S	10-12	17	22
M	14-16	18	23 1/2
L	18-20	19	25
XL	22-24	20	26 1/2

Does the camper have any allergies, chronic illness, or medical condition? If yes, please describe. Please list any medications. A registered nurse will be at the camp to administer all medications. A separate form must be filled out for medication that will need to be administered during camp hours.
Activity Track #1 - Choose one

Arts/Crafts Crazy Science Crazy Games Cooking/Baking
Activity Track #2 - Choose one different from Activity Track #1

Arts/Crafts Crazy Science Crazy Games Cooking/Baking
Sports Track #1 - Choose one

Soccer Basketball Kickball Street Hockey
Sports Track #2 - Choose one different from Sports Track #1

Soccer Basketball Kickball Street Hockey
Things to bring

Bible (one will be provided if they do not have one)

A change of clothes for each day especially Friday (they will get wet on Friday)

Beach Towel for Friday
Provided

Supplies for all activities

Snacks

Drinks

Lunch

Sunscreen
PERMISSION SLIP
Camper Name

First Name Last Name
has my permission to participate in Camp Discovery at Exmore Baptist Church located at 11624 Occohannock Road from Wednesday, August 10 - Friday, August 12. The undersigned, for ourselves, our respective heirs, executors, administrators and assigns, jointly and severally forecver release and discharge and agree to indemnify and hold harmless Exmore Baptist Church, and any and all participating sponsors, and directors, and teachers, and the administration, officers, employess and agents of such parties from and against any and all demands, claims for damages and causes of action, known and unknown, that the undersigned may have for any and all injuries to persons ro property in any manner arising or resulting from such participation in said event except only in such demands, claims or causes of action which may result from the gross negligence of any such party, such exception to apply only to such grossly negligent party. Each of the undersigned attest and verify that we have full knowledge of the risks involved in the participation in this event, that we assume these risks and that we will assume and pay any and all medical and emergency expenses of the participant in the event of an accident, illness, or other incapacity, regardless of whether we have authorized such expense, and that the participant is physically fit and sufficiently trained to participate in the event.
Parent/Guardian Signature

Clear
$35.00 Registration Fee must be sent in to Exmore Baptist Church, 11624 Occohannock Road, Exmore, VA 23350 or dropped off at the Church Office, Monday thru Friday, 9:00 - 5:00.

For special payment arrangements, please contact Karen Burton at 757-442-9491. No child will be turned away for inability to pay the registration fee.

Once the registration form and payment are received and processed, you will receive a registration packet including activity tracks for your child to sign-up for.
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Exmore Baptist Church Camp Discovery Registration

PERMISSION SLIP