Camp Registration Camp Holiday Registration Forms Page 1 Page 2 Page 3 Order Number 2020 Camp Holiday Registration Fields with red asterisks are required. The cost for each camper is $175.00 until March 30, 2020. Starting March 31, 2020 the registration fee will be $225. A. Please select the week(s) of camp that your child will be attending (Camp will be closed on Thursday & Friday July 2nd and 3rd) Week/s * June 22 – June 26 June 29 – July 1 July 6 – July 10 July 13 – July 17 July 20 – July 24 July 27 – 31 Aug 3 – Aug 7 Select your location: * Camp Holiday North B. Personal Information (Your child must be 5 Years of age to register) Your Child's Name * Age * Sex * Male Female Address * Apartment City * State * Zip * Date of Birth * School Church Name of Parent or Guardian * Primary Phone (Home or Cell) * Work Phone Emergency Contact * Relationship * Phone * Email Address * C. Medical Information Health Insurance Company * Policy Number * ID# * Allergies (No medications will be administered to a camper) Medications Health Concern * asthma bed-wetting constipation crying weak bladder fainting nose bleeds seizures upset stomach non-swimmer None Other PLEASE EMAIL AN UPDATED COPY OF YOUR CHILD"S SHOT RECORDS TO: [email protected]. NO CHILD CAN ATTEND WITHOUT IT. D. Authorization and Consent By clicking the checkbox that follows each statement below, you are providing your approval or consent to terms as stated. Photographs/ Videos Throughout the year, photographs, audio and videos may be taken of Community Changers Camp Holiday campers and used or published for educational purposes to promote camp or camp activities unless consent is withheld in writing and submitted to the camp by the parent or guardian. Photos and videos are regularly used on the ministry’s website and as well as submitted for publication to local media. Authorization * I Approve and Consent I approve of my child’s full participation in Camp Holiday activities. I consent to emergency medical attention treatment on my behalf. I understand that Camp Holiday assumes no liability for injuries or damages unless they are due to willful fault or negligence. I know of no physical limitations to my child’s participation in camp activities. I certify that the information on this form is true and correct to the best of my knowledge. Authorization * I Approve and Consent By entering my name below and clicking the "I Approve and Consent" checkbox, I certify that I am the parent or legal guardian of the Camper's Name in this registration form and am providing final approval and consent to all the terms above in Section D. By entering my name into the signature field below, I agree that it constitutes my electronic signature and is the equivalent, and has the same force and effect, of my handwritten signature. Name * Authorization * I Approve and Consent Date * E. Complete Registration - Check Out Camp T-Shirt Size Small Medium Large XL XXL Registration Fee $175.00 Quanity 1 2 3 4 Total * Total: Registrant Forms Camp Registration Health History Field Trip Transportation Before & After Care Authorized Pick-Up Volunteer Forms Volunteer T-Shirt Order
