Parents of Children S Campers

For Camp Staff use: KBC Children's Camp Registration Pd______Date

Camper______Age______DOB ______Sex_____

Home Address______

Home Phone______Business/Cell Phone______

Email address ______(you will receive email updates)

T-shirt Size (Remember it is better to go bigger than smaller): YS YM YL AS AM AL AXL

School Camper Attends______Grade Just Completed______

Parent/Guardian______

Emergency contact if parent cannot be reached______

______

Family Physician______Phone______

Family’s Church Home______

Does camper have any illness, allergies, or special medication or special needs of which camp staff should be aware? ______

Please staple a copy of your child’s insurance card here

(front and back)

I have read and understand the attached camp newsletter and agree to comply with its expectations of mine and my camper’s responsibilities. (ex; leaving camp grounds with written notice, behavioral expectations.)

Parent/Guardian Signature______Camper’s Signature______

In the event of an emergency, and the parents, guardian, doctor, or the above listed friend or relative are unable to be contacted, I (we) the undersigned grant permission to the Kingsville Baptist Church staff or representatives to take the above listed camper to the nearest medical facility or physician. Please attach a copy of your camper's insurance card. If insurance card is not applicable please circle n/a

Date:______Father/Mother/Guardian______

CHILDREN'S CAMP FEE ENCLOSED: $60.00______$130.00______$250.00______(NOTE: Day Camper fees are $60.00 per day camper; Overnight Camper fees are $130.00 per camper; Max per family is $250.00) After June 2nd : $70.00 ______$140.00 ______

**SWIMMING: While at camp, my child may swim in: (1) Shallow Area Only______(2) Any Supervised Area______(3) May Not Swim______

**Talent Show Application: List Talent (in detail) ______Approximate time of performance: ______

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HOLD HARMLESS AGREEMENT The undersigned hereby agrees to hold Kingsville Baptist Church, its Agents, Officers, Employees, or Members free from any and all liabilities, damages or injuries to the child or children of the undersigned that may occur traveling to, from, or during the Children's Camp to be held this year.

DATE:______SIGNED:______