Kids Camp 2025 & Zion UCC Enrollment Form

Youth/Child Enrollment Form

Summer 2025 (& Kids Camp) - Spring 2026
Name*
Birthdate*

MonthDayYear
Date
Age*
Grade*
Address*

Street Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Parent/Guardian Name*
Relationship to Child*
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone
Format: (000) 000-0000.
Email*
example@example.com
Address (if different from above)

Street Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Please list other adults that have responsibility for the child and have permission to make decisions or could be notified in the case of being unable to reach above guardian in emergency situations:
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Name
Relationship
Phone
Format: (000) 000-0000.
Alternate Phone
Format: (000) 000-0000.
Name
Relationship
Phone
Format: (000) 000-0000.
Alternate Phone
Format: (000) 000-0000.
YesNo
If yes, explain
YesNo
If yes, explain
Date of last Tetanus Immunization (If Applicable):
Month
Year
YesNo
If yes, explain
Food Allergies*
type "none" or similar if none
Drug Allergies*
type "none" or similar if none
Other medical needs, behavioral needs, or important information (Ex: if they receive accommodations or have an aid)
*Please note that this is not a commitment to meet all needs listed. We are a small team, but want to strive to accommodate when we are able. A member of the Kids Camp Team may contact you if we have follow-up questions.
EMERGENCY MEDICAL AUTHORIZATION

In the event of an emergency, I hereby give permission to the church staff or volunteers who are with my child to obtain medical assistance for my child. I also give permission to the physician selected to hospitalize and secure proper treatment for my child.
Parent/Guardian Signature*

Emergency Medical Authorization
Preferred Hospital
Insurance Company
Policy Number
TRANSPORTATION RELEASE

Initialing below acknowledges that I give permission for my youth/child to be transported to and from church sponsored activities in a church, rental, or private vehicle by church staff or other adults volunteering on behalf of Zion United Church of Christ.
Initial

Transportation Release
MEDIA RELEASE

In initialing this media release, I have approved photographs of my child to potentially be used for media and advertising for Zion UCC. These include things like photos on the Zion UCC website or shown through the Zion UCC's or staff's Facebook/Instagram pages, etc. If you do not initial below, know that they may still be taken, but your child's face will be blurred or covered when used in public forums.
Initial

Media Release
GENERAL RELEASE

The undersigned or a member of the immediate family of the undersigned realizes that the participant may incur personal injury or bodily damage while participating in such activities, and acknowledge that the church, it's officers, directors, employees, agents, or any other parties volunteering on behalf of the church, shall be held harmless from all actions, claims, costs, expenses or damages of any kind, growing out of or related to any activities of the church. The undersigned or a member of the immediate family of the undersigned further acknowledge this is a full and complete release for all injuries and damages which the participant may sustain as a result of participating in any activity.
I,your name*, being the legal guardian of child's name*, give my permission for him/her/them to participate in Zion UCC's sponsored activities.
Parent / Guardian's Signature*

General Release
Date*

MonthDayYear
Date
In initialing below, I indicate that my child (age 4- 6th grade) will be participating in one or more of Zion Kids Camps for summer 2025. Each Kids Camp is from 5:30-8pm. We will begin with a family dinner from 5:30-6pm. Then, the kids will begin their exploration through stories of the Bible with the theme, "Step Right Up!" Each camp will focus on different scriptures from the Bible to explore how God's love is for everyone! The evening will be filled with skits, games, activities, crafts, etc.*

Initials
June 11 - Step Right Up... and use the gifts God gave you!July 9 - Step Right Up... and thank God for forgiveness!August 6 - Step Right Up... and share God's love with everyone!
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Youth/Child Enrollment Form

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