Kidz Camp Registration Child's Name* First Last Age*Date of Birth* MM DD YYYY Grade Just Completed:*K1st2nd3rd4th5thGender*BoyGirlT-Shirt Size*Youth SmallYouth MediumYouth LargeYouth X-LargeChild's Image Consent* I grant permission I do not grant permission I hereby grant/do not grant permission for my child's image to be included in pictures, videos, promotional materials, and publications connected with South River Baptist Church. Parent/Guardian Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Emergency Contact Information - Name, Relationship, Phone#*Does Your Child Have Allergies?* Yes No If Yes to Allergies please specifyAny special needs?Check each week you would like for your child to attend.*Camps are for Boys and Girls that are rising 1st graders to graduated 5th graders. All Camps are Mon-Fri 8am-5pm and are $100 per week. Early Drop-off and Pick-up is available. Camp Week 1 - June 18th-22nd Camp Week 2 - June 25th-29th Camp Week 3 - July 2nd-6th Camp Week 4 - July 9th-13th Camp Week 5 - July 16th-20th Camp Week 6 - July 23rd-27th Camp Week 7 - July 30th-August 3rd Camp Week 8 - August 6th-10th Camp Week 9 - August 13th-17th Special circumstances...Please let us know if your child will only be able to attend certain days or if there are days that your child cannot attend camp.Who many pick up your child at the end of Summer Camp other than Parent or Guardian? List all names of those with permission.Is there a friend that your child would like be with during Summer Camp?Name of person registering child for Summer Camp*Email of person registering child for Summer Camp* Do you have a church home?* Yes No If Yes, where?