Queensway Baptist Church Registration Form
Kids Camp July 23-27 2018
Please fill out one registration form per child
First name of participant *
Your answer
Last name of participant *
Your answer
Gender *
Your answer
Date of birth (mm/dd/yyyy) *
Your answer
Age *
Your answer
Parent or Guardian first and last name *
Your answer
Relationship to the child *
Your answer
Mailing address *
Your answer
Email *
Your answer
Home telephone number *
Your answer
Cell phone number *
Your answer
Work telephone number
Your answer
Health card number *
Your answer
Allergies, medications or any information that you would find important for us to know
Your answer
Pick up Permission
For the safety of your child/children, we ask for a complete list of any and all people who are allowed to pick up your child. This ensures that the child is placed safely in the hands of people you trust.
Name and phone number of other people who can/may pick up the child during the week *
Your answer
Medical and Liability Release Waiver
Every activity sponsored by Queensway Baptist Church is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforeseen events can occur. By submitting this form, the parent or guardian agrees to assume and accept the risks and the hazards inerrant in sports and related social activities. They also agree not to hold Queensway Baptist Church, its members, staff or volunteers liable for damages, loss or injuries to the person or property undersigned. The parents or guardians understand that they are giving permission for the minor listed on this form for medical and liability release by electronically submitting this registration form. "In the event that I can not be reached in an emergency during the dates specified on this form, I hereby give permission to the physician or dentist selected by the church leadership to hospitalize, to secure proper treatment and or injection, anesthesia or surgery for my son or daughter deemed necessary." I grant permission for my child to participate in all children/youth ministry activities, indoors/outdoors and off sight, for the program year effective July 1 2018-August 31. I understand that photos and/or video footage of my child may be used for QBC's displays, promotional material, website and other ministry related activities within Queensway Baptist Church. In submitting this registration and consent form, I state that I understand the purpose for which my child's information will be used.
Name *
Your answer
Date (mm/dd/yyyy) *
Your answer
I agree with the Medical and Liability Release Waiver *
Required
YOU MUST AGREE WITH THE MEDICAL AND LIABILITY RELEASE WAIVER IN ORDER FOR YOUR CHILD TO PARTICIPATE
If your child does not attend on the first day of camp (July 23rd) or misses two consecutive days, his or her spot will be forfeited and given to another child on our waiting list to attend
Yes I understand and comply with this request *
Required
We will contact you to confirm your registration spot
Your child is not registered until you receive confirmation by phone or email *
Required
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