ClearView Kids Camp Registration
Welcome to ClearView Kids Camp 2018!

Starting Monday, July 9, kids entering GRADE 1 TO GRADE 5 are invited to join us for Rolling River Rampage: five days of adventure-filled learning. It is a week of unimaginable fun where children become "rafters" and experience the ride of a lifetime with God!

Date: July 9-13, 2018
Time: 9:00 am - noon. (half day only)
Registration deadline is Friday, June 22 at 1 pm!

Registration is ONLY COMPLETE when payment is received. See the PAYPAL link at the bottom of the page.

Child #1 Information:
Please register ONE CHILD at a time. Additional children can be registered on this registration form after completing parent contact and medical/emergency information.
Child's first and last name: *
Your answer
Child's gender: *
Child's Age: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Grade the child is entering in September 2018: *
School Attended: *
Your answer
Please list any allergies your child may have:
Your answer
Are there any other medical, physical, or social concerns you would like us to be aware of?
Your answer
Name one friend you would like in your crew (small group):
*please note: we will do our best to accommodate requests but we cannot make any promises
Your answer
Contact Information
Parent/Guardian's LAST Name: *
Your answer
Parent/Guardian's FIRST Name *
Your answer
Address: *
Your answer
City: *
Your answer
Postal Code *
Your answer
Home Telephone:
Your answer
Parent/Guardian Cell Phone Number: *
Your answer
Email Address: *
Your answer
Home Church:
As we prepare for this year's theme, "Maker Fun Factory," please consider joining our "production line" of workers that help make this week incredible. If you have an hour or so to offer, please let us know.
Medical and Emergency Information
In case of emergency, we should contact:
Name of emergency contact
Your answer
Emergency phone number: *
Your answer
Relationship to child(ren):
Your answer
Child #2 Information:
If you are only registering 1 child, scroll down to the "Payment Information" section.
Let us know who you are registering:
Child's first and last name
Your answer
Child's gender:
Child's Age:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Grade the child is entering in 2018:
School Attended:
Your answer
Please list any allergies your child may have:
Your answer
Are there any other medical, physical, or social concerns you would like us to be aware of?
Your answer
Name one friend you would like in your crew (small group):
*please note: we will do our best to accommodate requests but we cannot make any promises
Your answer
Child #3 Information:
If you are only registering 2 children, scroll down to the "Payment Information" section.
Let us know who you are registering:
Child's first and last name
Your answer
Child's gender:
Child's Age:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Grade the child is entering in 2018:
School Attended:
Your answer
Please list any allergies your child may have:
Your answer
Are there any other medical, physical, or social concerns you would like us to be aware of?
Your answer
Name one friend you would like in your crew (small group):
*please note: we will do our best to accommodate requests but we cannot make any promises
Your answer
After you make your payment below, RETURN TO THIS REGISTRATION FORM and hit the blue "SUBMIT" button to complete your registration.
Payment Information
Registration is FINAL ONLY AFTER PAYMENT HAS BEEN RECEIVED. Please note, the following links accept PayPal and other major credit cards. You do will receive an email confirmation from PayPal immediately after submitting your payment.

STEP 1 - Click on the link below that corresponds to the number of children you are registering and make a payment.
STEP 2 - **IMPORTANT**: Return to this Registration Form and press SUBMIT to have all your child's information sent to the church.


To register ONE CHILD, $50.00 click here:
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=VK8Y7M9R8PYEN

To register TWO CHILDREN, $100.00 click here:
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=GH59N3FT4RP7Y

To reigsiter THREE CHILDREN, $150.00 click here:
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=ZAJXRQKWA5TGC

YOU MUST RETURN TO THIS PAGE AND CLICK "SUBMIT" FOR YOUR REGISTRATION TO BE PROCESSED

Submit
Never submit passwords through Google Forms.
This form was created inside of ClearView Christian Reformed Church. Report Abuse - Terms of Service - Additional Terms