COPC KIDS' CAMP 24 online registration form

COPC KIDS CAMP 2024 online registration form

249 Airport Road Barre VT 05641
Covenant Kids' Camp July 22-26, 2024

Ages 5-12 8:30-noon
Please fill out a separate form for each child

problems with this form? email olivia@copcvt.org
Camper Name

First NameLast Name
Parent name 1

First NameLast Name
Parent Name 2

First NameLast Name
parent contact email
example@example.com
additional contact email?
example@example.com
age at camp
grade in school Sept 2024
gender of child

malefemale
home address
All parent/guardian phone or cell numbers
Food allergies or medication/health concerns [feel free to email separately]
Adults authorized to pick up child [child will not be allowed to leave w/out approved ride]
My child will be able to attend the end of the week show [Friday 12-1 pm] [Please type yes or no]
Medical and Liability Release Form

I acknowledge that participation in Covenant Kids' Camp involves risk to the Participant (and to the Participant’s parent(s) or guardian(s), if the Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.

In the case of a medical emergency I understand that every effort will be made to contact the parents or guardians. In the event I cannot be reached, I give my permission for my child to be treated by an accredited physician in an approved medical facility. I therefore designate camp staff with the authority to act on my behalf to secure any treatment plan directed by accredited medical staff for my child named above. I further release from any liability Covenant Orthodox Presbyterian Church and the adult leaders of Covenant Kids' Camp in the event of an accident associated with the Camp.

I authorize the use and dissemination of my child's likeness or image in both print and on the web.

If a dispute over this agreement or any claim for damages arises, the Participant (or Parent/Guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or Parent/Guardian) and Covenant Orthodox Presbyterian Church cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.
Parent type full name to authorize
Medical insurance name and ID number
COPC Kids’ Camp is open to all children in Vermont, regardless of economic, race or religious background. We will always be respectful of the campers’ rights to form their own religious convictions. In turn, we ask that campers show respect for our church’s statement of faith and practice [opc.org/confessions.html] and we reserve the right to require campers to withdraw from the program, if, in the Camp Director's opinion, a camper's behavior persistently disregards the camp rules: Safety, Kindness and Respect for others.

I have read and agreed to this statement
Should be Empty:

COPC KIDS CAMP 2024 online registration form

Covenant Kids' Camp July 22-26, 2024

Please fill out a separate form for each child