Kingsway Summer Camp Registration
Camper's Information
Last Name
*
First Name
*
Gender
*
Male
Female
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
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1984
1983
1982
1981
1980
1979
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1975
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1971
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1969
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1967
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1965
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1963
1962
1961
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1950
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1940
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade entering in the fall
*
7th
6th
5th
4th
3rd
2nd
1st
K
PreK
Address
*
City
*
State
*
Zip
*
Please select camp week(s) *Families are billed for weekly, not daily attendance
Week 1: June 1-5
Week 2: June 8-12
Week 3: June 15-19 (NO CAMP 6/19)
Week 4: June 22-26
Week 5: June 29-July 3
Week 6: July 6-10
Parent or Legal Guardian Information
Parent/Legal Guardian
*
Relation
*
Cell Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Home Phone
-
Area Code
Phone Number
Parent /Legal Guardian 2
Relation 2
Cell Phone 2
-
Area Code
Phone Number
Work Phone 2
-
Area Code
Phone Number
Home Phone
-
Area Code
Phone Number
Emergency Contact Info
If parent or guardian is not available
Emergency Contact Name
*
Emergency Number
*
-
Area Code
Phone Number
Emergency Contact Name
*
Emergency Number
*
-
Area Code
Phone Number
Authorized Pick-Up
I understand that the above named camper will only be released to the names listed below unless notification is sent via email.
Contact Name
Number
-
Area Code
Phone Number
Contact Name
Number
-
Area Code
Phone Number
Contact Name
Number
-
Area Code
Phone Number
Child's T-Shirt Size
4T
5T
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Email Confirmation
Parent's Email (confirmation will be sent by email)
*
example@example.com
Other Email
example@example.com
Other Information
How did you hear about Kingsway's Summer Camp?
*
Attend(ed) Kingsway
Friend
Church
Facebook
Instagram
Website
Other
First Time Camper?
Yes
No
Will you require before care (8am-9am) at an additional cost? $50/wk
Yes
No
Health Information
Are immunizations up to date?
*
Yes
No
Any activity the camper should be restricted from? Be sure to list any physical limitations.
List any allergies (ex: bees, peanuts, dairy)
List all medications, both prescribed and over the counter.
All necessary medication should be placed in labeled Ziploc bag.
Camper Photo Release
I agree that photos of my child can be taken and used for camp social media purposes.
*
Yes
No
Payment Information
Non-refundable $225 registration fee (first week's payment) can be paid via check or Zelle (kingswayprep@gmail.com). Registration is not complete without this deposit. Additional payments are due at the start of each camp week.
Be certain to enter your email address correctly on the registration form to receive further communication.
By submitting, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I certify that my child has my permission to attend camp and participate in all activites.
Electronic signature
*
Submit
Should be Empty: