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Kicking Bear 2019 Registration
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Attending Adult's Name
*
First
Last
Email
*
Phone
*
Child #1 Name
*
First
Last
Gender
*
Male
Female
Relationship of attending adult to child #1
*
Parent
Guardian
Mentor
If guardian, please specify relationship
Birthdate
*
Grade
*
Do you attend a church?
Yes
No
If yes, which church?
T-Shirt Size
*
YS (6/8)
YM (10/12)
YL (14/16)
Small
Medium
Large
XL
XXL
Please list any allergies we need to be aware of, particularly food allergies.
Emergency Contact (other than attending adult)
*
First
Last
Emergency Contact Phone #
*
Child #2 Name
First
Last
Gender
Male
Female
Attending adult's relationship to Child #2
Parent
Guardian
Mentor
If guardian, please specify relationship
Birthdate
Grade
Do you attend a church?
Yes
No
If so, which one?
T-shirt Size
YS (6/8)
YM (10/12)
YL (14/16)
Small
Medium
Large
XL
XXL
Please list any allergies we need to be aware of, particularly food allergies.
Emergency Contact (other than attending adult)
First
Last
Emergency Contact Phone #
Child #3
First
Last
Gender
Male
Female
Attending adult's relationship to child #3
Parent
Guardian
Mentor
If guardian, please specify relationship
Birthdate
Grade
Do you attend a church?
Yes
No
If so, which one?
T-Shirt Size
YS (6/8)
YM (10/12)
YL (14/16)
Small
Medium
Large
XL
XXL
Please list any allergies we need to be aware of, particularly food allergies.
Emergency Contact (other than attending adult)
First
Last
Emergency Contact Phone Number
Each child MUST be under the supervision of an adult at all times. The attending adult is responsible for the medical wellbeing of the child or children in their care. The adult listed in application is solely responsible for the release of the child to any other adult while on the premises of Camp Ozone.
Release and Waivers
Release and Waiver: The information given above is correct and complete as far as I know. I understand that there are risks of physical injury involved in camp activities, and I agree to accept the full risk as a part of my child’s participation. I further agree to indemnify, hold harmless, and defend Camp Ozone, its board members, executive officers, staff, and employees from any and all claims for injuries, damages, or loss sustained by me or my child arising out of, connected with, or in any way associated with Camp Ozone.
Promotional Release: I hereby give permission for the use of photos/videos in which my child may appear to be used for any promotional materials.
I have read and agree to the releases and waivers above.
Comment
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