Crossroads Camp Treasure Island - Registration Form
Please fill out the form below to register your child. Camp Treasure Island will be held at Crossroads Community Church from July 24 to July 28, 2017. Please submit a separate form for each child to be registered.

Cost of the camp is $5 per child or $10 per family. (Scholarships are available as needed - please contact the church if money is an issue).

Child Information
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
Your answer
Child's Grade in September *
Your answer
Siblings also attending
Include Age Groups (Emeralds, Rubies, or Sapphires)
Your answer
Allergies?
Foods (be specific), bee sting, etc.
Your answer
Are there any special instructions?
Your answer
My Child Will Be... *
Parent or Guardian Information
Parent/Guardian's Name *
Your answer
Relationship to Child *
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Telephone Number *
Your answer
Email Address
Your answer
Emergency Contact Information *
Name, Phone Number, Relationship to Child
Your answer
Place of Worship You Attend
Your answer
How did you learn about the camp?
Tell me more...
Waivers
My child is permitted to walk with their group to Cardington Recreation area for games. I agree to save and hold harmless Crossroads Community Church and its paid or volunteer staff from any injury sustained while participating in the Camp Treasure Island Program.

I hereby assign and grant to Crossroads Community Church the unqualified right to ownership, use, and proceeds of all photographs of me, without reservation or limitation, including use of photographs of me for advertising and promotional purposes.

Waiver Agreement *
Required
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