February Break Camp registration/Registro para el campamento de febrero
Use this form to register your kids for February Break Camp, Monday February 16 to Friday February 20, 2026. Please register each child separately.
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Child's full name/Nombres completos del niño
Child's full name *
Child's date of birth/Fecha de nacimiento del niño
Child's date of birth *
MM
/
DD
/
YYYY
Does your child have any food allergies we need to be aware of? Please list/Su hijo tiene alguna alergia de la cual debamos estar enterrados? Por favor confirme cuales
Food allergies *
Does your child have any additional medical or special needs we need to be aware of? Please list/Su hijo tiene alguna necesidad médica o asistencia especial de la cual debamos estar enterados? Por favor confirme cuales
Medical or special needs *
Parent/guardian 1 full name/Nombre completo del padre/guardián
Parent/guardian name *
Parent/guardian 1 phone number/Número de teléfono del padre/guardián
Parent/guardian phone number *
Parent/guardian 1 email address/Correo electrónico del padre/guardián 1
Parent/guardian email address *
Parent/guardian 2 full name/Nombre completo del padre/guardián 2
Parent/guardian name
Parent/guardian 2 phone number/Número de teléfono del padre/guardián 2
Parent/guardian phone number
Parent/guardian 2 email address/Correo electrónico del padre/guardián 2
Parent/guardian email address
Emergency contact full name/Nombre completo del contacto de emergencia
Emergency contact name *
Child's relation to emergency contact/Relación del niño con el contacto de emergencia
Relation to emergency contact *
Emergency contact phone number/Número de teléfono del contacto de emergencia
Emergency contact phone number *
Consent to Participate
As this child's parent or guardian, I consent to their participation in February Break Camp at Fourth Presbyterian Church and all activities that are part of this program. 

Como padre o guardián del niño, yo estoy de acuerdo en su participación en campamento de febrero en la Cuarta Iglesia Presbiteriana, y en todas las actividades que hagan parte del programa. 

I agree with the above statement (Consent to Participate) *
Required
Photo/Video Waiver
I grant to Fourth Presbyterian Church the right to take photographs of me and my family in connection with the February Break Camp program.  I authorize Fourth Presbyterian Church to use and publish the same in print and/or electronically. I agree that Fourth Presbyterian Church may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
I agree to the above waiver *
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