Hope Center Kids Camp 2024 - CAMPER registration

Camper Information

Camper's First and Last name

Male or Female

Male Female

Birthdate (mm/dd/yyyy)

Grade child will be entering in Fall 2024

Does your child have any dietary restrictions we should know about?

No Yes (please elaborate below)

dietary restrictions

If your child has any special needs, other allergies, or needing other accommodations that we should know about, please describe below. In order to make your campers experience the best it can be, someone from our Children's Ministry Staff may be contacting you in order to further discuss accommodations for your child.

BUDDY REQUEST (optional): Please list up to 2 friends, same grade, that your child would like to be in a group with. We will try to honor your request, however we cannot guarantee it.

Kids Camp t-shirts: All campers will get new t-shirts this year. Cost is included in the price of Kids Camp.

Parent/Guardian Information

Parent/Guardian 1 First and Last name

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 1 Phone

Parent/Guardian 1 Address

Parent/Guardian 2 First and Last name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Emergency Contact

Emergency Contact's Name

Relationship to camper

Emergency Contact's phone number

Digital Consent and Release

I, the undersigned, do hereby consent and agree that Hope Center Covenant Church, its employees, volunteers, and agents have the right to take photographs, videotape, or digital recordings of me and/or my minor child/children and to use them on the Hope Center website and/or social media accounts, exclusively for the purpose of showing real people on their website and/or social media accounts. I do hereby release to Hope Center Covenant Church, its employees, volunteers, and agents all rights to exhibit this work in print and electronic form publicly or privately. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in the Hope Center website and/or social media accounts. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback. I also understand that Hope Center Covenant Church, its employees, volunteers, and agents are not responsible for any expense or liability incurred, including medical expenses due to any sickness or injury incurred, as a result of my participation in a recording.

Yes No

LIABILITY RELEASE:
I, the undersigned, certify that I am the parent / legal guardian of above named Student (Camper), a minor, and that the Student is in good physical condition and able to participate in all activities for young people sponsored by Hope Center Covenant Church (the “Church”). I consent to the participation of the Student in any activity for young people sponsored by the Church in which the Student elects to participate (“Permitted Activities”).

In case of physical injury, illness or medical emergency of Student, I ask that you, the Church representatives, make reasonable attempts to contact me; however, if I cannot be reached, I authorize you to contact our family physician if he / she can be reached, and to take whatever measures are necessary to ensure the safety of the Student. This authorization and consent authorizes physicians, dentists and staff duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licenses, technicians or nurses to render the diagnosis, treatment or care they deem advisable for the Student in the exercise of their best professional judgment. I understand that every reasonable attempt to contact me will be made before providing diagnosis, treatment or care, time and conditions permitting, but that diagnosis, treatment or care may be provided in an emergency without my consent.

I / We have read and agree to all of the above terms, including without limitation to consent for my / our child, the above Student, to participate in Hope Center Covenant Church youth activities, medical treatment consent, and release of liability.

yes

E-signature

Payment

Payment $50.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Hope Center Kids Camp 2024 - CAMPER registration

Description

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