Camp Champion Day Camp

Camp Champion Day Camp 2019 Registration Form
Camp Champion Day Camp is for preschoolers ages 3 to kindergarten and 1st and 2nd graders! It will be from 9 until noon each day. We are excited to see your kids!
Camper Name
Last Name*
First Name*
Gender*

MaleFemale
Age/Grade entering in the fall 2019*
School
Church
Guest of
Camper's Information
Address*
City*
State*
Zip*
Home Phone*

Area CodePhone Number
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Parent or Legal Guardian Information
Parent/Legal Guardian*
Cell Phone*

Area CodePhone Number
Parent /Legal Guardian 2
Cell Phone 2

Area CodePhone Number
Email Confirmation

Confirmation of your registration and other camp information will be emailed
Parents Email
All fileds are required below. If nothing applies, please put "NONE" in the box. Thanks.
Any activity the camper should be restricted from?*
Any physical, mental or other condition that would require special attention or medication while at camp?*
List any allergies (ex: bees,peanuts, dairy)*
List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.*
Camper Release
Camper Release (List anyone, including parents, to whom your camper can be released)*
- Be certain to enter your email address correctly on the registration form to receive confirmation via email within 2 weeks
Camp Champion: Release of Liability, Warranty of Physical Fitness and Ability, and Media Release I ACKNOWLEDGE THAT BY HITTING SUBMIT AND INITIALING THIS DOCUMENT, I AM AGREEING TO RELEASE CAMP CHAMPION AND CONWAY’S FIRST BAPTIST CHURCH, INCLUDING ITS VOLUNTEERS AND EMPLOYEES, FROM LIABILITY.

Consent of Parent/Guardian: I represent that I am the parent/guardian of listed camper, who is under 18 years of age In consideration for allowing my child/ward to participate in Camp Champion activities, I hereby consent to the foregoing on behalf of my child/ward and agree that this Release shall be binding upon me, my child/ward, heirs, legal representatives and assigns. I also warrant that my child/ward is physically fit and able to participate in all Camp Champion activities except for those activities, in which I prefer my child/ward not to participate, which I have listed below. My permission is also given to obtain medical treatment for my child in case of an emergency. Conway's First Baptist Church has my permission to use any media that is my child’s image for promotional and/or commercial use.
Signature*

Clear
Electronic signature, please initial*
Camp Champion is free to all campers, but if you would like to make a donation, then click here and choose 'Camp Champion' in the dropdown box.

Donate to Camp Champion
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Camp Champion Day Camp 2019 Registration Form

Camper Name

Camper's Information

Parent or Legal Guardian Information

Email Confirmation

Camper Release