VBS/Summer Camp 2016 Registration Form

I. Camper Information:

Camper Name (Last) (First) ______(Middle) ______

School Name Grade Just Completed

Age ______DOB ______T-shirt Size (Youth: XS, S, M, L) ____ (Adult S, M, L, XL)

II. Family Information: Parent/Guardian #1 (First/Last/Middle) ______

Cell Phone ______Work Phone ______E-mail ______

Home Address City ______State ______Zip ______

Parent/Guardian #2 (First/Last/Middle) ______

Cell Phone Work Phone ______E-mail ______

Home Address (if different)______City ______State ______Zip ______

III. Camper Pick Up Authorization:

1. Name Relationship to Camper Phone

2. Name Relationship to Camper Phone

3. Name Relationship to Camper Phone

Parent/Guardian Authorization Signature:

IV. Program and Date Selection (check all that apply): 1. “Ocean Commotion” VBS ONLY (Free –– 9:00am -12:30pm Week 1 only) ______Wk 1_____June 13th – 17th (VBS extended care $60 by WKC*)

2. Wayside Kidz Camp ______3. Benny Fragela Extended Care**______4. Whiz Kidz Early Care*** ______

Wk 2 _____June 20th – 24th Wk 5_____ July 11th – 15th Wk 8_____ August 1st – 5th

Wk 3_____June 27 – July1st Wk 6_____July 18th – 22nd (George Camp Week—Surge!) Wk 9_____August 8th - 12th

Wk 4_____July 5th – July 8th Wk 7_____ July 25th – 29th Wk 10_____August 15th – 19th

*VBS extended care is available for $60. Care from 7:30-9am and 12:30-6pm, June 13th -17th only. Space is limited. **Benny Fragela Camp and Wayside Sports Camp attendees are eligible for an extended care for $7 a day or $35/week, 7:30-9am and 4-6pm. ***Whiz Kidz early care $10/week 7:30a-8am

VII. Medical Information:

Child's Physician: Phone:

Insurance Company: Policy # Phone: Please provide us of any learning disabilities, emotional or physical conditions: ______List any or all medications your child will bring with him/her to camp (medical form must be filled separately): Medical Condition: ______

Medications: ______

To be given when/how: ______

VIII. Allergies:

Medication Allergies: ______

Describe reaction and management of the reaction: ______

Food Allergies or Dietary Restrictions: ______Other Allergies (Include insect stings, hay fever, animal dander, etc.): ______IX. Photos:

May we use photos of your child in advertising for Wayside Baptist Church? Photos may appear in print or on our website. Yes______No______Informed consent for Emergency Treatment: In case of an Emergency and if I cannot be reached, I authorize the staff of Wayside Baptist Church to obtain whatever medical treatment he/she deems necessary for the welfare of my child. I further understand and agree that I will be responsible for all charges and fees incurred in the rendering of said emergency treatment regardless of whether or not my medical insurance would cover such charges or fees.

Print Name of Parent/Guardian:

Signature of Parent/Guardian: Date: 2016 Field Trip Information

Field Trips

We will hold one off site field trip this summer and 3 fun in house events. August 4th –TY Park Castaway Island in Broward County

COST Included with full paid tuition. Financial Aid Cost: $12 Transportation, entrance fees, and lunch are included.

Transportation provided by Maranata Bus Service.

• One permission form will cover any and all field trips and events listed that your child may be eligible to attend. • Your child must be registered for the camp week in which the field trip is scheduled. • Your child must wear their camp t-shirt and close-toed shoes on the event day. • Parents are welcome to attend, but must notify and pay the registrar in advance. • All Wayside Kidz Camp staff will attend field trip and events. No Kidz Camp staff will be on duty at Wayside Baptist Church during field trip. • Any specific information, i.e. wear a swimsuit, jacket, etc, will be provided on Monday before the field trip.

Wayside Baptist Church and Kidz Camp Field Trip Permission Slip & Release

Name of activities: Wayside Kidz Camp Field Trips 2016 Includes all dates on the Field Trip form. 1st Student’s Name: ______Grade: _____ Age: _____ Birth date: ____/____/____ Address: ______City: ______Zip: ______Best Phone #: (____) ___-______2nd #: (____) ___-______Emergency #: (____) ___-______Parent’s/Guardian’s Name: ______If “No”, list any medical information we should know about your child(ren): ______Release

The undersigned is the parent and/or legal guardian of the minor child(ren) named above (hereinafter referred to as “minor(s)”). The undersigned desires for said minor(s) to attend and/or participate in certain ministries, events, programs, functions, and activities (hereinafter referred to as “activity”), sponsored by, connected with, or related to Wayside Baptist Church (hereinafter referred to as “church”). I understand and acknowledge that the church will allow the minor(s) to participate in summer 2016 field trips only with my express permission. Likewise, the church will permit the minor(s) to participate based on my promise to hold the church harmless from liability arising out of the minor(s) attendance and/or participation in the activity listed above. This expressly includes the process of—and risks associated with—transporting minor(s) to and from the activity.

I hereby accept and acknowledge that the church may accept the assistance of certain companies and/or individuals to provide transportation. Each company or person shall be covered by one or more policies of insurance sufficient to cover the risks associated with such transportation. I affirm and acknowledge that, should any accident or incident arise during such transportation, the church shall not be liable for any injuries that may occur.

I have investigated—or will do so—all risks involved with the minor(s) attendance and/or participation in all summer 2016 field trip activities. Furthermore, as the parent or legal guardian of said minor(s), I accept—on behalf of myself and the minors listed above—any and all risks of personal or bodily injury to said minor(s) or property damages associated with said activity.

By signing this document, on behalf of myself and the minor(s), I hereby release and forever discharge the church, its pastors, officers, directors and employees, agents and any parties volunteering on behalf of the church from all claims, damages, costs or expenses of any kind arising out of or related to the minor(s) attendance or participation in church activities. I understand that this document is a full and complete release of all claims for personal or bodily injury and property damage which the minor(s) might sustain as the results of the minor(s) attendance and/or participation in any church activity, regardless of the specific cause thereof, and I further understand and agree that in the event of such personal or bodily injury to the minor(s), or property damage, that I (on behalf of myself or the minor(s) I will not seek any type of recovery from, or bring any type of action whatsoever against, the church or its pastors, officers, directors, employees, or agents.

PARENT / LEGAL GUARDIAN

______

Printed Name Signature Date

*A list of all field trips are available on our website: www.waysidemiami.org/camp or in the camp office. Signing up for KidCheck is easy and free for parents. Once you've created your account, you can add your children’s information and any pertinent medical/allergy alerts, and designate authorized and unauthorized guardians. You can also upload photos of yourself, your children and the guardians to help your childcare provider with identification. Sign-up 1. Go to the website https://go.kidcheck.com 2. Select “Register Now” 3. Fill in the requested !elds and create your password 4. Agree to the license agreement and then go to choose your account options 5. Select “Save Changes” My Account Page 1. Click on “My Kids”. This is where you will input your child’s information and upload photos. Select “Save Changes” when done. 2. Click on “My Guardians”. This is where you will input additional guardians and upload photos. Remember to “Save Changes” when you are done adding guardians. Your account is now complete! When you go to check in for the first time, type your 10 digit home or cell phone number onto the check-in screen, and your account will appear. Only facilities that you check-in to will be able to see your information, and only after you check-in for the first time. Remember to keep your information up-to-date. You can easily make changes to your account at any time by signing into your account at https://go.kidcheck.com