Hope Church

Camp HOPE Registration

Child

Name*

Age*

Date of Birth*

Preferred Nickname

Grade Entering in September*

Does your child have allergies, including food allergies?*

Yes

If so, please explain

Is your child able to participate in games and low-key sports?*

Yes

Does your child have any other special needs not mentioned above?

Parent/Guardian

Name*

Address*

Primary Phone*( ) -

Alternate Phone( ) -

Email*

What number can you be reached at during camp hours (M-F 9:00 to 12:00 am)?*

Primary

Alternate

Other

If other, enter here:( ) -

How did you hear about Camp HOPE?

Emergency Contact

(In the event we cannot reach you at the numbers given above)

Name*

Relationship*

Phone*( ) -

PLEASE LIST ANY OTHERS WHO HAVE PERMISSION TO PICK UP YOUR CHILD FROM CAMP*

(This includes the emergency contact. Your child will not be released to anyone other than individuals listed here)

Authorization/Permission/Liability Waiver

I, identified by the name given below, give permission for my child, identified by the child name given above, to attend Camp HOPE at Hope Church, and to participate in the activities thereof. I release Hope Church and the individual workers from liability in the event of injury to my child due to an accident. I give Hope Church personnel the authority to act on my behalf in the event of an emergency when I or the emergency contact person listed above cannot be reached. I also understand that photographs will be taken that may contain my child, and these photos may be used publicly, including but not limited to, the Hope Church website and bulletin boards.

Name*

Date*

Please leave this field blank.

What to Expect

What to Expect

Hope Church