Kids For Christ Camp 2024

Child Information

Name

Grade Just Completed

T-shirt Size category

T-shirt Size

Birthdate

Gender

Male Female

Address

Medical Information

Food Allergies

Yes No

If yes, please describe:

Is your child being treated for an injury/sickness or taking any medication?

Yes No

If yes, please describe:

Parent Information

Name of Parent(s) or Guardian(s)

Phone

This address will receive a confirmation email

Emergency Contact

Name

Phone

Bus Transportation

Areas covered: Mont Alto, Quincy, Downtown Waynesboro, & the Polktown Road community.

Transportation needed:

Yes No

Consent

I, the undersigned, being the parent or legal guardian of the child named above, do hereby consent to the participation of my child in the following activity conducted by Grace Baptist Church: Kids for Christ Camp. I certify that my child is physically fit and adequately prepared to participate in this event.

I, as the parent or legal guardian, give my consent.

I, the parent or legal guardian of a student participating in the Grace Baptist Church Kids for Christ Camp, grant Grace Baptist Church my permission to use photographs for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

I, as the parent or legal guardian, give my consent. I Do Not Consent

Medical Release

I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my child is injured or becomes ill. I authorize the Grace Baptist Church Pastor and/or Youth Pastor or another adult chaperone designated by the pastor to make emergency medical care decisions on behalf of my child, if required by law or a health care provider. I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care. I understand that Grace Baptist Church will not be responsible for medical expenses incurred solely on the basis of this authorization. I also understand that the designated adult chaperones reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child.

I understand.

Parent Signature

Kids For Christ Camp 2024

Description

Please Fix the Following