Church Camp Registration 2025

Child Information

Name

First Names of Additional Children (in the same family/with same last name. If you are the parent/guardian of a child with a different last name, please include that as well.):

Age (Please specify the age of each child if registering multiple children)

Allergies (please specify which child if registering multiple children):

Additional Information - Is there anything else you would like us to know?

Please list the T-shirt size of each child (Youth XS - Youth XL)

*New this year! We will offer an extra hour for kids to stay and eat lunch, and play some casual games. Will your child stay for lunch and be picked up at 1:00 pm? (Please note that if yes, you will need to provide lunch for Mon., Tues, & Wed. Thursday we will have pizza. Cost is the same regardless of pickup time)

Yes! No, thank you, I will pick my child/children up at 12:00 pm. Thursday only (we will provide pizza Thursday only)

Parent/Guardian Contact Information

Name

This address will receive a confirmation email

Phone

Address

Agreements & Signature

The undersigned does hereby give permission for my child/children to participate in WPC's kids' day camp. We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical reasons, disciplinary reasons, or otherwise, the undersigned shall assume all transportation. We (I) understand that there are certain inherent risks involved in activities such as this. We (I) hereby assume all risks and agree to hold harmless WPC and all leaders for any injury or damage, which may result from accident or mishap. (Parental/Guardian Signature in the box below)

I understand that photo and video may be taken of the VBS and consent to WPC using this content on their website and social media:

Yes No

Emergency Contact

Name

Phone

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

June 24 - 27, 2024, 9:00 am - 12:00 pm

WPC's 2023 Kids' Day Camp is happening June 23 - 26 from 9:00 am until 12:00 pm each day! Registration is open to children entering grades K - 5.

Please contact Anna Hadorn with any questions - anna.hadorn@windhamchurch.org

Church Camp Registration 2025

Description

Please Fix the Following