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#*Please use someone other than the parent's information already given above.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 and/or if they are not attending all week, select the days they will be attending during the week.*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 or $25 p/day. Early Drop-off and Pick-up is available. Camp Week 1 - June 17th-21st (full week) -----> Mon June 17th (Carpentry) -----> Tue June 18th (Trampoline Park) -----> Wed June 19th (Survivor) -----> Thu June 20th (Survivor) -----> Fri June 21st (Laser Tag) Camp Week 2 - June 24th-28th (full week) -----> Mon June 24th (Chef) -----> Tue June 25th (Emerald Gem Mine) -----> Wed June 26th (May Thai) -----> Thu June 27th (May Thai) -----> Fri June 28th (Giant Board Games) NO CAMP WEEK OF July 4th Camp Week 3 - July 8th-12th (full week) -----> Mon July 8th (Robotics) -----> Tue July 9th (LaserQuest) -----> Wed July 10th (Farming) -----> Thu July 11th (Farming) -----> Fri July 12th (Water Slide) Camp Week 4 - July 15th-19th (full week) -----> Mon July 15th (Plumbing) -----> Tue July 16th (Bowling) -----> Wed July 17th (Art) -----> Thu July 18th (Art) -----> Fri July 19th (Water Tag) Camp Week 5 - July 22nd-26th (full week) -----> Mon July 22nd (Police) -----> Tue July 23rd (Lazy 5 Ranch) -----> Wed July 24th (Music) -----> Thu July 25th (Music) -----> Fri July 26th (Laser Tag) Camp Week 6 - July 29th - Aug 2nd (full week) -----> Mon July 29th (Firefighter) -----> Tue July 30th (Mystery Hill) -----> Wed July 31st (Minute2WinIT) -----> Thu Aug 1st (Minute2WinIT) -----> Fri Aug 2nd (Field & Water Games) 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 to 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?