Child's Name:
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Grade Completed:
*
Please Select
3rd grade
4th grade
5th grade
6th grade
Child's T-shirt Size:
*
Please Select
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Parent / Guardian Name:
*
First Name
Last Name
Parent / Guardian Email:
*
example@example.com
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent or Guardian Phone:
*
Please enter a valid phone number.
Emergency Contact Phone Number:
*
Please enter a valid phone number.
Insurance Carrier:
*
Policy #:
*
Group #:
*
This child is currently taking the following medications (Note: all meds must be turned in to the Camp Nurse when you arrive at check-in):
This child has the following allergies:
This child has the following handicap:
If your child has someone they would like to bunk with, list that child's name here.
Terms & Agreement: By typing my full name, I certify that I am the parent/guardian of the registrant. I give my permission for stated child to go with Underwood Baptist Church to Kid's Camp at Earle Trent Assembly, July 23-25, 2025. I understand that sessions from Kid's Camp may be photographed or videotaped and that those photos and videos may be posted online or in printed promotional materials. I consent that being present at this event grants permission to use photos and videos. In the event of an emergency and I cannot be reached, I authorize Underwood Baptist Church, medical, or other professional personnel to take measures necessary to care for stated minor child.
*
My Registrations
*
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Kid's Camp
Includes lodging, meals and a T-shirt
$
100.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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