NW Naz Kids Summer Camp
Dates: August 5-10, 2018
Cost: $260
Location: Riverview Bible
Grade Levels: 3rd-6th grade
Initial Registration Deadline: July 23rd
Late Registration (Extra $25 Fee): July 29th, no registrations allowed after July 29th
All fees must be paid to the your home church. Each church will bring one form of payment to camp on August 5th.
**Limited space available: 100 girls & 70 boys. There will be a waiting list after we reach maximum capacity. If spots open up churches will be notified the week prior to the start of camp.
Email address *
1. Child's First and Last Name *
Your answer
2. Gender *
3. Birthdate *
MM
/
DD
/
YYYY
Grade Level Completed 2017-2018 SY *
4. Parent/Guardian Name(s) *
Your answer
5. Parent/Guardian Phone Number *
Your answer
6. Primary Address *
Your answer
7. Name of Church *
8. Food allergies, if none please skip
Your answer
9. Drug, Medication allergies, if none please skip
Your answer
10. Plant or Insect Allergies, if none please skip
Your answer
11. Medications- Prescriptions or OTC Currently Taking
Your answer
12. Pre-approved OTC Medications (Check All That Apply)
13. Activity Restrictions
Your answer
14. Family Doctor: Name and Phone Number *
Your answer
15. Tetanus Shot Date
MM
/
DD
/
YYYY
16. Roommate Request(s)
Your answer
17. Counselor Request(s)
Your answer
18. Camp T-Shirt Size *
19. Special Condition(s)
20. If you checked any boxes on #19 please explain below:
Your answer
If your child has any additional special circumstances you would like to share in order to help their camp experience please share below:
Your answer
In consideration of RIVERVIEW BIBLE CAMP, I for myself, or the minor child named below, forever waive, release and discharge RIVERVIEW BIBLE CAMP (and its parent corporation) from any/all injuries, claims, disputes, liabilities, or actions resulting from RIVERVIEW BIBLE CAMP providing services for me and for my benefit regardless of location for the dates identified above, except for injury or damage arising out of Riverview Bible Camp’s negligence or willful misconduct. I attest and verify that I have full knowledge of the risks and dangers involved; that I assume such risks, and that I will assume and pay my own medical and emergency expenses, in the event of an accident, illness or other incapacity, regardless of whether I have authorized such expenses. Any controversy arising out of, connected to, or relating to any matters herein of the transactions between me and the above named parties or on behalf of the minor child named below, of this Release/Waiver, or the breach thereof, including, but not limited to any claims of violations of Federal and/or State Law, as well as any common law claims shall be settled by arbitration through Christian Conciliation Services; and in accordance with this paragraph a judgment based upon the arbitrator's award may be entered in any court having jurisdiction thereof in accordance with the provisions of R.C.W. 7.04. This agreement shall be construed and interpreted under the laws of the State of Washington. I HAVE READ THIS WAIVER AND RELEASE CAREFULLY, AND UNDERSTAND IT. *
Parent Electronic Signature *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service