Registration for Kindness Camp

Who are you registering for camp?

Kindness Camp was created with the elementary-age child in mind.
(K-5th grade)
We will have childcare available for younger children (0-5 yrs) of parents who volunteer for camp.
If you would like your older child to participate as a "Junior Leader" please let us know.

Child #1 Name

Child #1 Birthday

Grade in the Fall

Child #2 Name

Child #2 Birthday

Grade in the Fall

Child #3 Name, Birthday & Grade

Child #4 Name, Birthday & Grade

Parent/Guardian Contact Information

Name

Relationship to child(ren)

This address will receive a confirmation email

Phone

Pick Up & Drop Off Information

Parents/Guardians have the option of "drive thru" check in and drop off at Kakao at 9 AM or at Compass House at 9:30 AM. Our team will escort children from Kakao to Compass House in time for camp to begin at 9:30 AM.
Lunch will be served at 12 noon at Compass House. Parents/Guardians can sign out and pick their child(ren) up at 12:30 PM at Compass House or 1 PM at Kakao.

Where are you planning to drop off/pick up your child(ren)?

Kakao Compass House

Emergency Information

I hereby release, forever discharge and agree to hold harmless, Union Church, its elders, directors, employees and volunteers, from all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above named child that occur during any activities. Furthermore, I hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in these activities. The undersigned further agrees to hold harmless and indemnify Union Church, its elders, directors, employees and volunteers, for any liability sustained by said church as the result.

Agree

Please sign (First & Last name)

Emergency Contact (In case Guardian is unavailable)

Phone

Relationship to child

Medical Release Statement

I, as the parent or legal guardian of the child(ren) listed on this form herein authorize the adult sponsor of Union Church to consent to any X-ray, examination, anesthetic, medical or surgical diagnosis or treatment, on the advice of any physician or surgeon licensed to practice in the state of treatment, when the need for such treatment is immediate, and when efforts to contact me are unsuccessful.

Agree

Please sign (First & Last Name)

Personal Physician

Phone

Insurance Company

Policy Number

Do the attending children have any food allergies or dietary restrictions, medications we should be aware of?

Additional information that would be helpful for camp staff to know about attending child(ren). Please include medical conditions.

Parent Volunteer and Childcare Information

Name

Area of volunteering Food Games Crafts Welcome activity Story/Lesson Registration Decor

Names & ages of children you need childcare for

I give permission to Union Church to do a background check on volunteers listed above. Yes No

Registration for Kindness Camp

Description

Please Fix the Following