CAMPER INFO & CONSENT FORM

GraceSquad Kids' Camp • 2025

Please read and complete the following form for EACH child you are registering. Questions marked with an asterisk * are required.

CAMPER INFO

Camper First Name

Camper Last Name

Age

Birthdate

Gender

Parent/Guardian Cell Phone #1

Parent/Guardian Cell Phone #2 (If Applicable)

Parent/Guardian Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Camper's Grade Level

Kids' Camp is open to elementary age children in 1st through 5th grade. Please choose which grade level your child will enter into THIS fall.

Grade Level

Note: if you selected "other" in the previous question, please provide additional info below re: which grade level your child will enter into this fall.

Optional. See above note.

Camper's T-Shirt Size

Each camper will receive a t-shirt at no additional cost. Youth and adult sizes are available. Please list the camper's shirt size below.

Camper's T-Shirt Size

Camper's Home Church

Name of Camper's Home Church

CAMPER CODE OF CONDUCT AGREEMENT

Please be sure your child understands and agrees to the following statement: "As a camper at the GraceSquad Kids' Camp, I agree to abide by the rules and policies of the camp during my time at camp. I understand that any deliberate breach of conduct or disregard of camp rules will necessitate disciplinary action, even to the extent of being asked to leave the camp."

By electronically signing below, you affirm your above-named child understands and agrees to abide by the GraceSquad Kids' Camp rules and policies.

Signature

MEDICAL INFORMATION

Allergies

Please use this section to list any known allergies to insects, medications, etc. and treatment required (i.e. EpiPen, Benadryl). NOTE: Use the next section to list any known food allergies.

Allergies

Food Allergies or Sensitivities

Please use this section to list any food allergies or sensitivities.

Food Allergies

Diagnosed Medical Conditions

If your child has any diagnosed medical conditions of which we should be aware, please list those below.

Diagnosed Medical Conditions

Prescribed Medications/Treatments

Please list any medications / treatments your child is currently being prescribed by his/her physician.

Prescribed Medications/Treatments

Additional Health/Behavioral Conditions

Does your child any other health or behavioral conditions of which we should be aware? If so, please list those below.

Additional Health/Behavioral Conditions

Restrictions from Physical Activities

If the camper has been restricted from participating in certain physical activities by his/her doctor, please list those here.

Restrictions from Physical Activities

Name/Contact Info of Child's Doctor

Primary Health Insurance Info

Please list insurance company name and phone number, as well as, child's policy and/or group number.

Primary Health Insurance Info

PARENT / GUARDIAN INFORMATION

Parent / Guardian First Name

Parent / Guardian Last Name

Relationship to Child?

Parent/Guardian Contact Phone

Alternate Contact

Please provide the name, phone number, and relationship to child of an alternate person whom we may contact in the event we cannot reach you.

Alternate Contact Name/Phone/Relationship

PICK-UP / DROP-OFF INFORMATION

Who will DROP OFF your child at camp?

Who will PICK UP your child from camp?

Alternate Pick-Up / Drop Off Persons

List up to three people authorized to pick-up your child in an emergency. Photo ID will be required at pick-up.

Alternate Pick-Up / Drop-Off Persons

RESTRICTED Pick-Up / Drop Off Persons

Please list any individuals the camper should NOT be released to (or visited by) due to a court order.

RESTRICTED Pick-Up / Drop-Off Persons

PARENT / GUARDIAN CONSENT

Please read through the following section carefully. By selecting "yes", you are confirming you have read, understand, and agree to each of the following statements.

1. Liability Waiver

I hereby give my permission for my child to participate in any of the activities of the GraceSquad Kids' Camp, and waive all claims to injury or loss of property arising out of the activities against the leader(s) of this camp, the other participants, and Grace Fellowship Church.

Do you agree to the Liability Waiver statement?

Yes, I understand and agree.

2. Insurance Coverage

I understand the camp insurance policy provides secondary coverage only. My insurance will provide primary coverage.

Do you agree to the Insurance Coverage statement?

Yes, I understand and agree.

3. Emergency Medical Treatment

Part 1 of 2: I hereby consent to allow camp officials to seek and secure medical treatment for my child in the event of an emergency. I will provide a copy (front and back) of my insurance card on or before the first day of camp.

Do you agree to Part 1 of the Emergency Medical Treatment statement?

Yes, I understand and agree.

Part 2 of 2: As parent/guardian of the above named child, I also affirm that the information on this application is true and correct and that in case of illness or accident, you have my permission to administer first-aid and/or to secure medical attention for my child. Furthermore, I hereby authorize the release of all medical records (x-rays, test results) resulting from treatment to the GraceSquad Kids' Camp / Grace Fellowship Church. I also give my permission for my child to participate in and travel to any off-site activity sponsored by the camp, if necessary (prior notice will be given to parents/guardians in the event that an off-site activity is scheduled).

Do you agree to Part 2 of the Emergency Medical Treatment statement?

Yes, I understand and agree.

4. Photo Release

I hereby give permission for my child to be photographed and/or filmed while participating in activities associated with the GraceSquad Kids' Camp and for such images to be used for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

Do you agree to the Photo Release statement?

Yes, I understand and agree.

TOTAL NUMBER OF CHILDREN ATTENDING

How many of your children (from within the same household) will be attending camp?

SUBMISSION (Please Read)

Once you have completed and submitted a Camper Info & Consent (CIC) Form for ALL children attending from within your household, please return to the Kids' Camp webpage and proceed to Step 2: Registration & Fee Payment.

If you have any questions, please contact Mrs. Katelyn. We are SO excited to have your children joining us for this year's camp!