P & W Kids Camp 2023
If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)

If you have previously registered with us for a prior event, you can search for your stored information instead of filling out the form below.
Personal Information
*Participant's First Name:
*Participant's Last Name:
*Address:
*City:
*State:
*Zip:
*Gender:
*Birthday:
(MM/DD/YYYY)
*Last Grade Completed:
*T-Shirt Size:
*Sponsor Church:
*Insurance Carrier:
*Insurance Policy Number:
*Allergies,Medical,&Special Needs:
*Date of Last Tetanus Shot:
(**/**/****)
*List Medications,Dosages,& times:
*Can Your Student take Acetaminophen:
((Tylenol))
*Can Your Student take Ibuprofen:
*Can Your Student take Stomach Ache Remedy:
*Parent/Guardian Name:
*Home Phone:
(555-555-5555)
*Cell Phone:
(555-555-5555)
*Email:
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
(555-555-5555)
*Emergency Contact Name (2):
*Emergency Contact Phone (2):
(555-555-5555)
*Authorized Pickup #1:
*Authorized Pickup #2:
Authorized Pickup #3:
Authorized Pickup #4:
I understand my student may be photographed:
(during camp)
I understand my student's photo may be used:
(to promote future camps)
Comments:
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