Day Camp 2025

Parent/Guardian Name

This address will receive a confirmation email

Phone

Address

Emergency Contact

Emergency Phone Number

Which days will your children be attending?

Monday, August 4 Tuesday, August 5 Thursday, August 6 Friday, August 7 All Week

Child 1 Name

Gender

Male Female

Birthday

Grade (What grade is your child going into?)

T-shirt Size

Any food allergies or medical concerns?

Child 2 Name

Gender Male Female

Birthday

Grade (What grade is your child going into?)

T-shirt Size

Any food allergies or medical concerns?

Child 3 Name

Gender Male Female

Birthday

Grade (What grade is your child going into?)

T-shirt Size

Any food allergies or medical concerns?

Child 4 Name

Gender Male Female

Birthday

Grade (What grade is your child going into?)

T-shirt Size

Any food allergies or medical concerns?

Permission to use Images and Video & Consent and Release Form

I hereby grant permission to Kerwin Baptist Church to record sounds, images, or video of my Child(ren) while attending this Day Camp. I also give permission for Kerwin Baptist Church at its sole direction, to use these sounds, images, or videos in publications (including print, website, and social media platforms) owned by Kerwin Baptist Church in relation to this Day Camp. I the undersigned parent or guardian, hereby consent to my child(ren), participating in the Day Camp, an event sponsored by Kerwin Baptist Church Kidville Children’s Ministry on August 4-5 & 7-8,2025. I certify that my child can participate in these activities. In the event an emergency occurs, I may be reached at the telephone number listed. I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITY, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold KERWIN BAPTIST CHRUCH and its agents and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of North Carolina and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.

YES NO

Signature

Today's Date

Day Camp 2025

Description

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