Kiddo Camp!

Hurry! Get
your child
in on the
Kiddo Camp
action...

To register for Kiddo Camp, complete the form below. A $50.00 NON-REFUNDABLE deposit is REQUIRED with every registration. Your registration is not complete until we have received your deposit, which can be paid in person at our church office. Our enrollment is limited and is on a first-come basis. Please contact Mrs. Eddie Lee with questions regarding registration, deposit or Kiddo Camp in general.

Camper Information

Name*

Address*

City*

State*

Zip*

School*

Birth Date*

Grade Completed*

Gender*
Boy Girl

Are you a Christian?*
Yes No

Shirt Size*

Church*

Cabin Requests (one per line):

Medical Information

Doctor's Name*

Doctor's Phone*

List any allergies, medications, or other physical restrictions we should know about*

Parent/Guardian Contact Information

Mom

Name

Home Phone

Contact me first

Work Phone

Cell Phone/Pager

Dad

Name

Home Phone

Contact me first

Work Phone

Cell Phone/Pager

Step-parent/Caregiver

Name

Home Phone

Contact me first

Work Phone

Cell Phone/Pager

Spouse (if applicable)

Additional Contact Information

If we cannot be reached in an emergency, contact:

Emergency Contact #1*

Phone*

Cell/Pager*

Emergency Contact #2

Phone

Cell/Pager

I understand that Valley View Church will not be held liable for injury or accident.