King's Camp 2019 Registration Form
Please fill out all sections in their entirety.
Email address *
Name of Camper , Age, Date of Birth , Last Grade Completed *
Your answer
Name of Camper, Age, Date of Birth, Last Grade Completed
Your answer
Name of Camper , Age, Date of Birth, Last Grade Completed
Your answer
By checking this box, I understand and fully comply that my child is fully potty trained and does not require a pull up. *
Required
Camper(s) Home Address (City & Zip code) *
Your answer
Mother's Name , Cell Phone Number , Functioning Email Address *
Your answer
Father's Name , Cell Phone Number , Functioning Email Address *
Your answer
Name of Emergency Contact , Contact Phone Number, Functioning Email , Relationship to Camper(s) *
Your answer
Secondary Name of Emergency Contact , Contact Phone Number, Functioning Email , Relationship to Camper(s)
Your answer
Names of All Individuals Authorized for Pick Up and Release , their Contact Phone Numbers, Functioning Email , Relationship to Camper(s) *
Your answer
By checking this box, I authorize that all information above is truthful, factual, functioning, current, and I guarantee authorized pick up and release to the individuals stated above. *
Required
By checking this box, I authorize that all information above is truthful, factual, functioning, current, and I guarantee authorized pick up and release to the individuals stated above. *
Required
Throughout the summer, campers will be attending various field trips led by King's Camp Counselors. Your digital signature below signifies your consent for your child to participate in these activities. You are also giving your permission for these counselors to transport your child to and from the field trips. Your child's safety is our first concern. The possibility of accidents should not be overlooked. Some things are beyond our control. We cannot absolutely guarantee your child's safety. Your signature below shows that you understand this and releases the counselors and congregation of legal liability should such an accident or injury occur. I hereby give my consent for my child to participate in King's Camp field trips on and off site activities: *
Required
If you , as a parent, would like to accompany us for a particular field trip, please let the counselors know the Monday before the field trip. You will be responsible for paying your own way for the field trips and for additional cost incurred on the field trip. You may certainly drive your own child if you accompany us, but the rest of the campers will remain under the supervision of the Camp counselors. Parents may chaperone their own children, but the four counselors still reserve all authority while on these trips. I hereby give my consent for my child to participate in King's Camp field trips on and off site activities: *
Required
By Florida law, car seats are required for all children 5 and under. Please all of the boxes below that apply to your child/children: *
Required
Would you classify your child's/children's swimming ability as beginner or non-swimmer, intermediate, or expert(deep-end swimmer with ease)? *
Your answer
I understand the risks associated with swimming, and hereby give my consent to allow my child to participate in all swimming activities. *
Required
(Optional) Include here any additional helpful comments about field trip and/or swimming activities:
Your answer
In case of serious accident or illness at King's Day Camp, someone trained in first response will call the paramedics. This may result in your child being sent to the nearest hospital if further medical treatment is recommended. Parents or legal guardians will assume full financial responsibility for ambulance and medical expenses incurred on behalf of your child for such treatment. Do you fully understand this policy and hereby give my permission to any trained Kings Day Camp employee to look after the wellbeing of my child and administer any medication that they may need. *
Required
Physician's Name and Contact information: *
Your answer
Do you have a preferred local hospital? *
If yes, what is your preference?
Your answer
Does your child have any physical restrictions? *
If yes, please explain in detail:
Your answer
Does your child have any dietary restrictions? *
If yes, please explain in detail:
If medications are needed, please dictate the name of the medication, dosage, time administered, start date, and end date
Please indicate the possible side effects of the stated medication
My child/children will be tentatively coming the following weeks to camp: *
Required
FEE:I understand that registering before May 7th will result in a reduced registration fee of $25 per child. *
FEE: I understand that registering after May 7th will result in a regular registration fee of $50 per child. *
FEE: I understand that by registering my child for King's Camp and by sending my child to King's Camp, I will pay $150 weekly for the first child. Any additional children will pay $130. *
FEE: I understand that by sending my child to King's Camp there is no financial aid or scholarships offered and the Director will not give any special deals to any camp family because there are many financial obligations that need to be met to run this camp smoothly and effectively. *
Referral Credit: I understand that any camp family can receive a $25 refund on their camp fees by referring a new family to camp. However, to receive the $25 refund, the new family needs to attend camp for at least 3 weeks. *
Additional T-shirt Fee: I understand that the registration fee pays for every camper to receive a camp t-shirt. Any additional t-shirts requested will receive a $10 fee. *
Required
Please indicate T-shirt sizes of your campers by name. *
Required
Finally, Please read each statement and check each box in agreement. *
Required
By signing my name below, I am agreeing that I have read through all statements thoroughly, that I am in agreement with all fees, and that I authorize all activities at King's Camp. *
Your answer
A copy of your responses will be emailed to the address you provided.
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