Kids Camp Registration

July 10 - 13, 2017

 

Name *
Name
Select the grade your child will be ENTERING in the Fall 2017 school year.
Parent/Guardian Name *
Parent/Guardian Name
Phone *
Phone
Alternate Phone *
Alternate Phone
Address *
Address
Do you currently have a church home? *
Emergency Contact 1 *
Emergency Contact 1
(Please list a person we can contact in the event you (the parent/guardian) cannot be reached. (Neighbor, friend, or relative who has permission to pick up your child)
Phone *
Phone
Address 1 *
Address 1
Emergency Contact 2 *
Emergency Contact 2
(Please list a person we can contact in the event you (the parent/guardian) cannot be reached. (Neighbor, friend, or relative who has permission to pick up your child)
Phone *
Phone
Address *
Address
Name of Child's Physician *
Name of Child's Physician
Physician's Phone Number *
Physician's Phone Number
Does your child have any health concerns we should be aware of? *
Liability Release *
I hereby give my consent for the child listed above to participate in Kids Camp. I agree to hold harmless the Woodward Park church of Christ, its employees, and the Kids Camp staff from any and all liability from injury, claims, costs or loss of service which might be incurred by participation in said programs, activities, or events. I, the undersigned parent or guardian authorize the camp directors to secure any and all necessary treatment for the named camper in the case of any emergency, illness or accident. I, the undersigned, specifically release Woodward Park church of Christ and any parent or staff from responsibility for any accident or illness that may occur during the week of Kids Camp. I have read the above statements carefully and sign it voluntarily with full knowledge of its significance.