Kids Kamp Registration

Kamper Name

Parent/Guardian Name

This address will receive a confirmation email

Phone

Address

Emergency Phone Number

Gender

Male Female

Birthdate

Age

2024 Grade Level Completed

Church Affiliation

Shirt Size

Youth - 14/16 Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL

Disclaimer

By submitting this form, I understand that my child(ren) will not be allowed to bring any electronic devices (cellphones, handheld game devices, etc) nor weapons of any kind. I understand that if my child(ren) brings anything inappropriate, I will be called to come pick the item(s) up and my child(ren) may be sent home from kamp without a refund.

I also give permission for my child(ren) to be photographed during children’s ministry events and for my child(ren)’s picture to be used in church publications such as, but not limited to: church website as well as Kids Kamp and Children’s Ministry promotions.

I am the parent/guardian of the listed Kamper and I give permission for my child to attend Kid's Kamp 2024 and recognize that Resurrection Life Church is not responsible for any injuries inflicted upon any participating parties.

I acknowledge that I have read and understand the disclaimer above

Yes

Kids Kamp Medical Form

Emergency Contact Name & Relationship

Emergency Contact Phone Number

Other instructions in case of emergency

Health History

Have or subject to (check if yes) Asthma Fainting Spells Convulsions Diabetes Heart Trouble Allergies and/or reaction to any meds, bee stings, foods, etc... Swimming or sports restrictions Other

Please Describe:

Have difficulty with (check if yes) Ear, nose, throat Digestion Bed Wetting Lungs Sleep Walking Other

Please Describe:

Have Had (check if yes) Measles Chicken Pox

Any condition now requiring medication?

Please list all medications, dosage, and directions as prescribed by the child's physician. This includes all medications taken on an as needed basis.

Any additional special needs?

Medical Authorization

This health history is correct so far as I know and the person herein described has my permission to engage in all prescribed activities except as noted by me. In the even I cannot be reached in an emergency, I hereby give permission to the physician selected by the adult leader in charge to hospitalize, secure proper anesthesia or to order injections or surgery for my son or daughter.

I agree to the medical authorization above

Yes

Fees and Payments

Kamp Fee: $175/Kamper ($25 retainer fee due now)
Your non-refundable retainer fee of $25 (per kamper) will reserve a space for your child(ren) and will be applied toward the full registration cost.
The full registration cost of $175 is due JUNE 9, 2024. No refunds on the remainder of the registration cost after JUNE 9, 2024.

SPACE IS LIMITED! FORM AND DEPOSIT MUST BE RECEIVED BY MAY 19, 2024 TO RESERVE YOUR SPOT.

Please make checks payable to: Kids Kamp
Mail any forms and payment not completed online to:
Resurrection Life Church - Attn: Rusty Greenwood
1085 W McKinley Ave
Decatur, IL 62526

If paying online, please follow the link to our giving page.
In the drop down field, please choose "Kids Kamp Fees"
In the 'memo' field, please enter the name of your Kamper.
This link will open a new window, be sure to come back to this screen and submit your application before closing your browser.

Pay Kids Kamp Fees Online

Kids Kamp Registration - 2024

Description

Kids Kamp Registration - 2024

Description

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