KCC Kids Camp "Lighthouse" Registration

Name of Child #1

Child #1 Grade Completed

2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Child #1 T-Shirt Size (Earlier Sign-ups Get Size Priority)

Allergy Concerns/Medication for Child #1

Name of Child #2

Child #2 Grade Completed 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Child #2 T-Shirt Size (Earlier Sign-ups Get Size Priority)

Allergy concerns/medication for Child #2

Name of Parent/Guardian

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Phone

Parent/Guardian Address

Name of Emergency Contact

Emergency Contact Phone

Payment

Medical Release: By selecting "I agree," you understand that in the event that medical treatment is required, every effort will be made to contact you. If you cannot be reached, you hereby authorize Kerrville Church of Christ, its staff and event volunteers as an agent for yourself to consent for medical treatment by hospital medical staff, EMT, and other medical professionals. This form will be surrendered to the medical staff so they may be aware of any known medical issues. This authorization is effective from the date of signing this form.

I Agree

Liability Release: By selecting "I agree," you release Kerrville Church of Christ, its staff, members, adherents and otherwise attached from all liability and responsibility for property, belongings and self at church functions and the functions of its ministries.

I agree

Photo/Video Release: Lastly, do you give permission for your student to have their picture taken at youth and church activities for promotional materials that may or may not be placed on our website or social media. Full names of children will not be published.

Yes, I give permission No, I do not give permission.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

KCC Kids Camp "Lighthouse" Registration

Description

Please Fix the Following