Registration for Kids Kamp & Next Level

Child's Name *
Child's Name
Gender *
Date of Birth *
Date of Birth
School Grade Completed (as of June 2017) *
Address *
Home Phone *
Home Phone
Cell Phone
Cell Phone
Mother's Name *
Mother's Name
(Or primary female caregiver)
Father's Name
Father's Name
(Or primary male caregiver)
Who has custody? *
Does your child have any allergies or medical concerns? *
For the safety of your child, you will also be asked to fill out a Medical Form.
In Case of Emergency Please Contact: *
In Case of Emergency Please Contact:
Emergency Contact Phone # *
Emergency Contact Phone #
Photo Waiver *
I give permission for photos of my child to be taken for Kids Kamp activities and for use within our church presentations and website.
Child Drop Off/Pick Up Authorization
As parent/guardian, I hereby authorize the following persons to drop off/pick up my child from Fairview Baptist Church for Kids Kamp. I hereby agree to inform the following persons that proper identification may be required in order to drop off/pick up my child.
Authorized Drop Off/Pick Up Personnel
Authorized Drop Off/Pick Up Personnel
If groups are mixed ages, that means your child can be paired with any other children registered. List one or two that you would like to be on the same team as your child.
The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. Do you agree to indemnify and hold harmless Ministry personnel , Fairview Baptist Church, its pastors and elders from and against any loss, damage or injury suffered by your child as a result of being part of the activities of Fairview Baptist Church, as well as of any medical treatment authorized by supervising individuals representing the church. This consent and authorization is only effective when participating in or traveling to events sponsored by Fairview Baptist Church. *
Fairview Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the child to the appropriate classes, to develop and nurture ongoing relationships with your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Fairview Baptist Church to limit the information collected, or to view your child's information, please contact us. *
Registration Fee
There is a $10 registration fee per child, to a maximum of $30 per family. This will be collected on the first day of camp. *
We don't want any child to miss out because of this new registration fee, so we have some scholarships available. If you would like to access our scholarship fund, please indicate below.