AGAPE Overnight Camp Registration
**FOR AGES 9-15**
Child's Name *
First and last name
Birth Date *
MM
/
DD
/
YYYY
Age *
Answer ex: 12
Grade *
Answer ex: 8th
School Child Attends *
Gender *
T-Shirt Size *
Adult Size
Camp Sessions and Dates. Please select which camp(s) your child will be attending. *
Required
Has the child attended overnight camp before? *
Child's Name #2 (If you have more than one child attending camp)
First and last name
Birth Date
MM
/
DD
/
YYYY
Age
Answer ex: 12
Grade
Answer ex: 8th
School Child Attends
Gender
Clear selection
T-Shirt Size
Adult Size
Clear selection
Camp Sessions and Dates. Please select which camp(s) your child will be attending.
Has the child attended overnight camp before?
Clear selection
Child's Name #3  (If you have more than two children attending camp)
First and last name
Birth Date
MM
/
DD
/
YYYY
Age
Answer ex: 12
Grade
Answer ex: 8th
School Child Attends
Gender
Clear selection
T-Shirt Size
Adult Size
Clear selection
Camp Sessions and Dates. Please select which camp(s) your child will be attending.
Has the child attended overnight camp before?
Clear selection
Child's Name #4  (If you have more than three children attending camp)
First and last name
Birth Date
MM
/
DD
/
YYYY
Age
Answer ex: 12
Grade
Answer ex: 8th
School Child Attends
Gender
Clear selection
T-Shirt Size
Adult Size
Clear selection
Camp Sessions and Dates. Please select which camp(s) your child will be attending.
Has the child attended overnight camp before?
Clear selection
Parent/Guardian #1 *
First and Last Name
Cell Number *
Address *
Home Number
Work Number
E-mail *
Parent/Guardian #2
First and Last Name
Cell Number
Home Number
Work Number
E-mail
Medical Acknowledgement  *

I understand that I will be notified in the case of a medical emergency invovlving my child. In the event that I can not be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. 

In His Steps Ministries will NOT BE LIABLE for any reaction to medication dispensed by the child, parent, or gaurdian on In His Steps premises. 

Permission is also granted to In His Steps Ministries and its affiliates including Directors, Camp Counselors & Volunteers to provide the needed emergency treatment prior to the appearance of a medical professional. 

Required
Emergency Contact's Name *
First and Last Name
Relationship *
Phone Number *
Alt. Number
Emergency Contact's Name #2
Relationship
Clear selection
Phone Number
Alt. Number
Does the Student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the child prescribed any medication? If yes, please explain any instructions.
Does the child require a special diet? If yes, please describe & explain any instructions.

PLEASE READ: In His Steps will host four overnight camp sessions in total. There will be two camps held for boys only, and there will be two camps held for girls only. Campers are encouraged to attend Part I and Part II of each Camp. The fee per camp is $100. 

NOTE: If your child attends one camp session, your total is $100. If your child attends two camp sessions, you total is $200. 

 *
Required

ATTENTION: Spots are limited!!! Spots are secured by a first come, first serve basis. In order to secure a spot a NON-REFUNDABLE deposit of $30 per camp which means if your child will be attending two camps your deposit is $60 (this does go toward your total cost) and is to be paid using this link: https://www.google.com/url?q=https://giving.ncsservices.org/App/Giving/ncs-1689&sa=D&source=editors&ust=1736266771979355&usg=AOvVaw1zgxZvrjqZ_0M9Q0Zl3yQd 

 or our Cash App- $InHisStepsMS (IF YOU ARE USING CASH APP, PLEASE BE SURE TO PUT IN THE NOTE: CAMP DEPOSIT or REMAINING BALANCE,YOUR CHILD'S NAME, & YOUR NAME!)


 *
Required
Remaining Balance Payment Option *

I agree that In His Steps Ministries and its officers, directors, employees, volunteers, and agents are NOT LIABLE for any accidents, injury, medical expenses, or other damages that may be incurred by my children on the premises of IHS campus or other facility used by In His Steps Ministries, or during any activity sponsored, or conducted by In His Steps. I further agree to indemnify, defend, and hold harmless In His Steps, its officers, directors, employees, volunteers, agents from any and all causes of action that may be brought against them a as result of any injuries or damages incurred by my children while participation in any In His Steps sponsored activities. 

*Permission to attend field trips/outings planned by In His Steps Ministries. I understand that my child will be transported in an insured vehicle at all times. 
*Permission to be photographed or videotaped by In His Steps Ministries' staff or other photographer I understand that these videos/photographs will only be used to promote the ministry of In His Steps. 
 *
Required

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

 *
Please Type Name For E-Signature
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