Kids Camp 2019 Registration
Thursday, June 27- Saturday, June 29, 2019
Registration Dates: February 17- June 1, 2019 or when spots are filled.
Camp Price is $220
Deposit of $100 must be paid at time of registration for the camper's spot to be held.
Payment (cash or check) also accepted on Sunday mornings at the Next Gen Center in the Foyer at both Brazoria Rd and MCC

Deposits are non-refundable.

Parent Meeting on June 24, 2019 via Facebook Live
Camper's First Name *
Your answer
Camper's Last Name *
Your answer
Grade (CURRENT) *
Gender *
Age *
Your answer
Birthday *
MM
/
DD
/
YYYY
T-Shirt Size *
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Name of 2 friends your camper would like to room with
Your answer
What campus does your camper attend? *
Parent Name(s) *
Your answer
Parent Phone Number *
Your answer
Parent Alternate Phone Number
Your answer
Parent's Current Email (important camp information will be sent to this email) *
Your answer
Parent Alternate Email
Your answer
Family Physician's Name *
Your answer
Family Physician's Phone Number *
Your answer
Does your child have Health Insurance? *
Name of Insurance Policy
Your answer
Insured Name
Your answer
Insurance Phone Number
Your answer
Policy Number
Your answer
ID Number
Your answer
Generally, my student's health is: *
If fair or poor, please explain condition:
Your answer
Do you plan to bring any medications to camp with you? *
If yes, please list medications:
Your answer
May your child have the following at camp: (please check the ones that are approved) *
Required
Has your student have a previous/recent injury or surgery? *
Does your student have a chronic medical condition or any other health concern? *
If YES to any of the previous questions, please describe:
Your answer
Date of last tetanus shot: *
MM
/
DD
/
YYYY
Please list any allergies (food, drug, insect stings/bite, etc):
Your answer
I, ___________________the parent/legal guardian/adult leader/or student 18 years or older) of this student, a minor, hereby acknowledge that said minor is presently under my care, custody and control. I hereby give this minor my permission to go to Carolina Creek on June 27-29, 2019. I further grant my permission for this child to participate in all activities of said event. In the event of an emergency, necessitating medical attention, I hereby consent and give my permission to Brazos Pointe Fellowship’s representatives, leaders, or any attending physician to make such decisions and to perform such medical treatment and/or surgery upon said minor, which may in their sole discretion, be necessary and proper under the circumstances. I understand that every effort will be made to contact me in the event of such an emergency. I do release, acquit, discharge and covenant to hold harmless Brazos Pointe Fellowship, Lake Jackson, TX and all representatives of Brazos Pointe Fellowship, Lake Jackson, TX, from any and all actions, damages, and liabilities arising out of the treatment of any sickness or accident incurred by said child during the trip dates. I also give authority and permission to trip sponsors to inspect mine or my student’s belongings while on the trip for the safety and protection of all participants if circumstances make it necessary. Parent and/or Guardian (or student 18 years of age or over in agreement with above waiver): Please type your name to serve as your signature. *
Your answer
PHOTO/VIDEO/MOVIE RELEASE I, _________________, the parent of this student, a minor, hereby give permission to Brazos Pointe Fellowship to photograph my child and use such photographs in all forms of BPF media, for any and all promotional purposes including publicity, display and audiovisual use.I understand that the term “photograph” as used herein encompasses both still photographs and audio and video recording footage. Please type your name to serve as your signature. (Leave blank if you do not approve.) *
Your answer
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