AC NEXT GEN Kids Camp REGISTRATION

Camp Info

Students will need to bring with them a peanut free lunch, water bottles, and a change of clothes.

We will be providing snacks but we will not be providing lunches.

Payment

Registration fee is $50.00 a day per child.

On Form Payment

Child Info

Name

Address

Home Phone

Birthdate

Gender

Age

Parents/Guardians

Parent/Guardian 1

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Mobile Phone

Address (if different)

Parent/Guardian 2

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Mobile Phone

Address (if different)

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Medical Info

Family Doctor

Doctor Phone #

Allergies

Medical Conditions

Disclaimer

I/we the parent or guardian understand that I need to provide a lunch for my child every day they participate in Kids Camp.

Yes I recognize that a lunch needs to be sent with my child

I/we, the parent or guardian, authorize the Aurora Cornerstone Ministry Personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above, should it prove necessary.

Yes No

I/we, the parent or guardian, undertake and agree to indemnify and hold harmless Program Personnel; Aurora Cornerstone, and its leaders from and against any loss; damage or injury suffered by the participant as a result of being part of the activities of Aurora Cornerstone, as well as of any medical treatment authorized by the supervising individuals representing organization. This consent and authorization is effective only when participating in or traveling to events sponsored by Aurora Cornerstone.

Yes No

I/we, the parent or guardian, grant the Aurora Cornerstone Church full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group’s aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases and funding applications.

Yes No

I have read, understood and agree with above and sign it to cover all Children's Ministry activities for the program year effective as stated below, A separate Informed Letter of Consent will be sent home for offsite activities and activities of elevated risk.

Yes No

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

AC NEXT GEN Kids Camp REGISTRATION

Description

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