Home › Form Test Form Test Camp Sonrise Camper Registration Form Camper Information Camper's First Name (Put preferred name in " after legal name) Camper's First Name Camper’s First Name (Put your preferred name in ” after your legal name.) Camper's Last Name Camper's Last Name Date of Birth Date of Birth Age Age (At the Time of Camp) Gender Male Female Gender School Name of School Enrolled In Grade Nursery Pre-K K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Grade Your Child Will Be Going To Church Name of Church Presently Attending T-Shirt Size Y-XS Y-SM Y-MED Y-LG A-SM A-MED A-LG A-XL A-2XL A-3XL T-Shirt Size - $10.00 Canteen Card No Yes Canteen Card ? Canteen Card Value $5.00 $10.00 Canteen Card Value Baptism Options (You Must Check One) My child may be baptized. My child may not be baptized. My child may be baptized, but I need to be contacted first. Contact Me Parent/Guardian/Primary Contact Primary Contact First Name First Name of Parent/Guardian/Primary Contact Primary Contact Last Name * Last Name of Parent/Guardian/Primary Contact Father's Name Father's Name Mother's Name Mother's Name Address Street City City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Select State Zip Code Zip Code Email Address Email Address (Don't have one, enter none@none.com) Home Phone Home Phone Cell Phone Cell Phone Work Phone Work Phone What Is the Best Way To Contact You? Home Phone Cell Phone Work Phone Email OtherOther May We Add Your Email Address To Our Mailing List? Yes No If you select "Yes " you will receive information about our future events and more information about camp. If you select "No" you will only receive an email with more information about camp. (Ex.) Rules, Where & what time to meet, what to pack, etc. Emergency Contact Information Please provide two additional people, different from the parent/guardian listed above, who would automatically be the first person we contact. First Contact First Contact's Name Relationship Relationship To Camper Listed Above Phone Number Home Phone Phone Number Work/Cell Phone Second Contact Second Contact's Name Relationship Relationship To Camper Listed Above Phone Number Home Phone Phone Number Work/Cell Phone Medical Information The information below is not required. Health Insurance Policy/Member ID Policy Number/Member ID Health Insurance Provider Health Insurance Provider Primary Physician Primary Care Physician Address Primary Care Physician Address Phone Number Phone Number Hospital Preference Hospital Preference Medical Conditions Please List All Known Medical Conditions, Including Any Requiring Maintenance Medication (i.e. Diabetes, Asthma, Seizures) Below So We Can Accommodate Your Camper’s Needs. (Add As Many Lines As You Need By Clicking The Add Button Below) Medical Condition Required Treatment Should Paramedics Be Contacted? Yes No Add Remove Continued.. Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason? No YesYes Is your child allergic to any type of food or medication? No YesYes Does your child require a special diet? No YesYes Emergency Authorization I, the undersigned, parent or guardian of the above named individual, acknowledge that staff of Camp Son Rise take every precaution to provide for the safety of all students, however participation in camp activities necessarily involves risk of physical injury. I further acknowledge that the programs of Sonrise family camp are administered by adults, who volunteer their time, rather than by paid, trained professionals. In consideration for accepting the registration of the above named individual and permitting the voluntary participation of said individual in its programs, I (for myself as well as for my child, his/her heirs and assigns) hereby release, discharge and hold harmless Forest Park Church of Christ and its employees, camp director, volunteers and other representatives or affiliates (including without limitation the facilities and volunteers) from and against any and all claims arising out of or relating to illness, physical injury, death or other damages that may result to said individual while participating in a Forest Park Church of Christ sponsored event, including any physical injury by negligence of any volunteer while performing his/her duties during any practices or games. I attest that my child is physically capable to participate in this event. However should camp director/volunteers/pastoral staff (Jason Corder or Bob Blanshan) determine in their sole discretion that completion or participation in any events would be injurious to my child’s health or should my child become ill or injured, I consent to his or her removal and treatment by any physician or medical care provider at the direction of the volunteers, camp director and staff. Signature By signing below you agree that you have read and understand the above form, the camp rules, and you and your child agree to their conditions. Signature Clear Your Legal Signature Today's Date Today's Date reCAPTCHA Total Due
