1st thru 6th Grade Camp
June 17-21
Cost: $250
$50 deposit per camper due by March 17th
 
For partial payments click here
or use Text-to-Give | 330.536.9599 - keyword KCAMP
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Interested in joining us as a leader? Register here.
 
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Gender *

To reserve your space, a $50 non-refundable/non-transferable deposit per camper must be received.

Friends

We will make every effort to place camper with one friend in their age group. Camper may not choose a leader.

PARENT(S)/GUARDIAN INFORMATION

TRANSPORTATION

Please be advised that the church is not responsible for transportation. Parents/guardians are
responsible for transportation to and from camp.

FUNDRAISING

All fundraising dollars raised for this event will be evenly divided. The success of the fundraising is
dependent upon everyone’s participation in the fundraiser.
Do you wish to receive funds for KIDZ Camp? *
If no, you will be allowing those who have a financial need to receive a greater amount of the
fundraising dollars.
If yes, please be prepared to participate in ALL of the fundraisers:

CONTACT INFORMATION

FUNCTIONS AND ACTIVITIES

It is my understanding that participation in the programs and recreational and other activities of Victory Christian Center is a privilege. Prior to my child’s participation in such activities, I acknowledge that certain risks are associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportationrelated accidents, illness or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.
       The undersigned herby give our consent to and authorize the minor child named above to participate in all events conducted by Victory Christian Center. I further authorize my minor child to travel with representatives of Victory Christian Center in private or other vehicles to any such events so conducted.

FIRST AID AND EMERGENCY MEDICAL TREATMENT

I recognize that there may be occasions where the child named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for the agents of Victory Christian Center to seek and secure any needed medical attention or treatment for the child named including hospitalization, if in the opinion of the agent such a need arises. Further, I authorize the agent of Victory Christian Center to consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is rendered under the general or special supervision of, any physician, surgeon, or dentist licensed under the laws of the State or County in which the medical care is being sought and on medical staff of any hospital. In doing so I agree to pay all fees and costs arising from this action to obtain medical treatment including any treatment a physician, surgeon, or dentist may deem necessary.
        It is understood that this authorization is given in advance of any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care being required, but is given to provide authority and power on the part of the agent to give specific consent to any and all such examination, anesthetic, diagnosis, treatment, or hospital care which the aforementioned physician, surgeon, and/or dentist, in the exercise of his/her best judgment, may deem advisable. I hereby authorize any hospital which has provided treatment to my child to surrender physical custody of the child to the agent upon completion of the treatment.

PUBLICITY

On the occasion, Victory Christian Center takes photographs or makes an audio or videotape recording of children and/or adults involved in church activities, such photographs or video records may be used by staff and participants to remember the activities and participants. In addition, such photographs and audio/visual recording may be used in Victory Christian Center publications or advertising materials to let others know about our ministry. In addition, local news organizations may hear of our activities or events, and Victory Christian Center may allow them to photograph or record our events for news reporting on special interest features. I consent to the use of any such audio or visual record of the child named above to be used, distributed, or displayed as the agents of Victory Christian Center see fit. This consent includes but is not limited to: photographs, videotapes, audio recordings, and Victory Christian Center’s web page.
Publicity *

RELEASE OF LIABILITY

By signing this form, I expressly warrant that the child named above is capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the child participating in the activities, whether such risks are known or unknown to me at this time. I, the undersigned, for my child, my child’s personal representatives, assigns, heirs, distributees, guardians, and next of kin, hereby irrevocably and unconditionally release, waive, discharge, and covenant not to sue Victory Christian Center and its ministers, leaders, employees, volunteers, and agents, for and from all claims of any nature now and hereafter existing whether known or unknown, including but not limited to, all liability to the Releasors, on account of injury to my child or death to my child or injury to the property of the child, whether caused by the negligence of Victory Christian Center, its ministers, leaders, employees, volunteers, and agents or otherwise, during the course of my child’s participation in the activities, arising out of or in connection with activities related to Victory Christian Center, or any travel connected therewith.

PARENT OR GUARDIAN SIGNATURE

I represent that I am the parent/guardian of...
...who is under 18 years of age. I have read the above form and am fully aware of the contents thereof. I give permission for the child named above to participate in the activities of Victory Christian Center, including any special events/activities. In consideration for allowing the participation of the child in activities of Victory Christian Center, I hereby consent to the above terms on behalf of the child and agree that this form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns.
Signature of Parent or Legal Guardian *
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BASIC HEALTH AND SAFETY INFORMATION

MEDICAL HISTORY
HEALTH INSURANCE AND MEDICAL DOCTOR

MEDICATIONS

I give permission for the camp health officer to administer any over the counter medications deemed necessary while at camp. This includes, but is not limited to, fever relief, itch relief or pain relief medications. *
Your camper is NOT REGISTERED until you make a $50 deposit/camper.
For partial payments click here
or use Text-to-Give | 330.536.9599 - keyword KCAMP
Help with Text-to-Give