Kids Camp 2025 Registration

Child's Information

Child's Name

Date of Birth

Gender

Male Female

Grade Completed

T-shirt Size (YXS-AXL)

Food/Medical Allergies

Medication Instructions (Please list all medications your child takes daily with specific instructions. Please bring it in a ziplock bag labelled with child's name. Medications will need to be given to the designated chaperone)

Parent Information

Parent/ Guardian #1

Parent /Guardian #1 Phone

Next Person we should call in an emergency (Name & Number):

Parent Email

This address will receive a confirmation email

Would you like to be added to Kids Camp 2025 remind for camp updates?

Yes No

Insurance

Name of Insurance Company

Policy #

Insured's Name

Medical & Photo Release

My child has permission to go to Earle Trent Assembly in Lauderdale County, AL to Kids Camp, June 21-23. I am giving permission for him/her to travel and be under the care of First Baptist Colbert Heights. I further give my permission for first aid or medical attention to be administered in case of an accident/injury. I will not hold FBCCH, staff, or chaperones responsible for any accident that may occur. Please type your name below.

I hereby grant First Baptist Church Colbert Heights (FBCCH) permission to use my likeness in a photograph for use on FBCCH websites, without payment or any other consideration. I hereby irrevocably authorize FBCCH to publish this photograph for purposes of publicizing FBCCH programs or for any other lawful purpose. I hereby hold harmless and release and forever discharge FBCCH from all claims, demands, and causes of action that I have or may have by reason of this authorization. I understand that FBCCH is a non-profit organization, and that photos published will not be used for any commercial purpose. FBCCH will not publish the identity of any minor(s) pictured in the photographs provided, although the name of the affiliated organization may be identified.

Yes No

Payment (If you choose to pay cash or check, please select that option)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Kids Camp 2025 Registration

Description

Please Fix the Following