CAPS Camp Love Registration Form

CAPS I.D. *

Will you be utilizing CAPS? *

Email *

Child's Name (First and Last) *

Gender *

Age *

Date of Birth *

Highest Grade Completed (by June 1, 2024) *

What date will your child start Camp Love? *

How many sessions will your child attend? *

1 May 28 - June 7

2 June 10 - June 21

3 June 24 - July 5 (Camp will be closed July 4th and 5th)

4 July 8 - July 19

5 July 22 - August 2

My child will attend all sessions.

Child's T-Shirt Size *

Parents' Names (First and Last) *

Home Address (City, State, and Zip Code) *

The state law requires Immunization Records. Please upload your child's immunization records here.

Medical Emergency Information: I, hereby give the director of this camp permission to take my child, to a hospital or family doctor for treatment when I cannot be reached or when a delay in medical care would be dangerous to my child. Sign Here *

Prefered Hospital *

Doctor's Name and Phone Number *

I acknowledge that the Camp transports campers on several Field Trips and hereby give my permission for my child to participate (swimming requires a separate permission). Sign Here *

Persons responsible for pickup other than parents: (List 3) (Name and Phone number) *

Please list any medical, food or special concerns of your child:

*

How did you hear about Camp Love? *

Flyer

Magazine

Billboard

Other

I acknowledge that Camp Love Summer Enrichment Experience is exempt from Bright from the Start licensure (Initial Here) *

I acknowledge that Friendship Community Church carries liability insurance for the Camp Love Summer Enrichment Experience (Initial Here) *

I acknowledge that I have read and understand the expectations of Camp Love Summer Enrichment Experience and agree to abide by its terms and adhere to payment as identified. Sign Here *