Kid's Camp 2023

July 16th-20th | Please fill out this form and click submit.

Camper's Information

Child's Name

Age

Gender

Please select one option.

Male Female

Birthdate

Grade Going Into

Please select one option.

1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Allergies (Food or Other)

Medical concerns

Other concerns (behavioral, emotional, etc...)

Name of Friend also attending

Shirt Size

Please select one option.

XS S M L XL 2XL 3XL

Parent/Guardian Information

Parent/Guardian's Name

What is your relationship to the child?

Please select all that apply.

Mother Father Legal Guardian Grandparent Other Relative Family Friend

Address

Phone

Secondary Phone

This address will receive a confirmation email

Who is authorized to pick child up?

Emergency Contact Information

Name of Emergency Contact

Phone

Relationship to Camper

Emergency Release Form

Emergency Release Form: I give my permission to the staff of Family Worship Center to seek medical attention for my child if necessary while participating at Superhero Kids Camp. I understand that all necessary precautions will be taken for my child's safety. I will not hold the church, church staff or church volunteers liable.

Please select all that apply.

I agree

Doctor's Name

Doctor's Phone

Insurance Provider

Policy Number

Payment Information

Price of camp is $250 with an aditional $7.00 processing fee.

There is a $50 deposit required when registering ($2.00 processing fee). The $200 balance must be paid on-site by July 2nd, 2023.

Deposits and Full Registration are non-refundable.

Payment

Deposit (Remainder is paid on site) ($52.00) Full Registration ($257.00) Already Paid In-Person (0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

July 16th-20th

Please fill out this form and click submit.

Kid's Camp 2023

Description

Please Fix the Following