FAMILY REGISTRATION FORM
Faith ColumbiaPress Play Kids CampJuly 12 - 16, 20219 am - Noon3 years through completed 5th gradeMust be potty trained.
Registration cost is: $25/child, Max $60/familyAfter June 14 cost is: $30/child, Max of $70/family
STEP 1: Complete the registration form below and hit submit. Then, continue to our payment site. Registration is complete once this form AND payment have been received.
Parent/Guardian #1 *
Parent/Guardian #1 Cell*( ) -
Parent/Guardian #1 Email*
Parent/Guardian #2
Parent/Guardian #2 Cell( ) -
Parent/Guardian #2 Email
, AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Home Phone( ) -
YES
Church Name
NO
We would like to receive more information about Faith.
Disclaimer (Photo and Video Release)
I hereby grant Faith Lutheran Church permission to copyright and use images and videos taken at Kids Camp of any minor(s) designated on this form in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied. I understand that there will be no compensation for participating in photo/video shoot.
Choose:* I DO grant permission as stated above. I DO NOT grant permission as stated above.
Parent/Guardian Initials*
By typing your initials you are consenting to the statement above.
Child 1 Name*
DOB* January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001
Male
Female
Grade Completed*
School
T-Shirt Size* Youth XS Youth S Youth M Youth L Adult S Adult M Adult L
Name of Child's Friend*
*We will make every attempt to place your child(ren) in the same small group as their friend(s).
Allergies/Special Needs
Child 2 Name
DOB January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001
Grade Completed
T-Shirt Size Youth XS Youth S Youth M Youth L Adult S Adult M Adult L
Child 3 Name
Child 4 Name
Child 5 Name