Kidz Camp Registration Child's Name* First Last Age*Date of Birth* MM DD YYYY Grade Just Completed*Gender*BoyGirlChild'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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Emergency Contact Information - Name, Relationship, Phone#*Does Your Child Have Allergies?* Yes No If Yes to Allergies please specifyAny special needs?Summer Camps Offered - Check all that you would like your child to attend.* Outdoor Camp - June 26th-30th Art Camp - July 3rd-7th Princess & Knight Camp - July 10th-14th Adventure Camp - July 17th - 28th Camps are for Boys and Girls that are rising 1st graders to graduated 5th graders. All Camps are Mon-Fri 8am-5pm and are $85 per week. Early Drop-off and Pick-up is available.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?