Advance Kids Adventure Camp 2026 Camper Registration Form

Parent/Guardian Information

Parent/Guardian Full Name:

Email:

This address will receive a confirmation email

Phone Number:

Address:

Emergency Contact Information

Emergency Contact Full Name:

Emergency Contact Phone Number:

Emergency Contact Relation to Child(ren):

Child #1 Information

(1) Full Name:

(1) What grade did your child finish June 2026?

(1) Please list any allergies or special instructions that will help us best care for your child.

Child #2 Information

(2) Full Name:

(2) What grade did your child finish June 2026?

(2) Please list any allergies or special instructions that will help us best care for your child.

Child #3 Information

(3) Full Name:

(3) What grade did your child finish June 2026?

(3) Please list any allergies or special instructions that will help us best care for your child.

Child #4 Information

(4) Full Name:

(4) What grade did your child finish June 2026?

(4) Please list any allergies or special instructions that will help us best care for your child.

Medical/Liability Release Form

I/we, below named parents/guardians authorize the Pastors, ministry staff, and volunteers of Southwest Community Church to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant(s) named above.

I/we, named below, undertake to agree to indemnify and hold blameless Southwest Community Church, its ministry staff and volunteers from and against any loss, damage, or injury suffered by the participant(s) as a result of being part of the activities of Southwest Community Church, as well as of any medical treatment authorized by the supervising individuals representing Southwest Community Church. This consent and authorization is effective only when participating in or traveling to events hosted by Southwest Community Church.

Do you agree to give medical/liability release to Southwest Community Church as stated above?

I agree. I do not agree. I would like more information.

You, the parents/guardians, authorize by typing your name and date into the blank below, hereby verify that you have read and agree to the above release form. This is your electronic signature.

Photo & Video Release Form

I/we, parents/guardians named below, permit the children named above to be included in photographs, audio recordings, and videos that may be used for display in Southwest Community Church, its informational and promotional publications, including websites, newsletters, and church ministry presentations.
I/we understand that no reference to my child(ren)'s name(s) will be made alongside such images and that I/we will not receive compensation for the use of these images.

Do you agree to give photo/video release to Southwest Community Church as stated above?

I agree I disagree I would like more information

You, the parents/guardians, authorize by typing your name and date into the blank below, hereby verify that you have read and agree to the above release form. This is your electronic signature.

Payment

If for any reason the price of camp makes it inaccessible for your family please email jen@southwestchurch.ca and we will cover the cost.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Advance Kids Adventure Camp 2026 Camper Registration Form

Description

Please Fix the Following