Summer Camp Registration

Child's Information
Child's Name*
First Last
Age*
Date of Birth*
Month
Day
Year
Grade Just Completed:*
If registering before the end of the school year, use current grade.
Gender*
T-Shirt Size*
Check each week and or days you would like for your child to attend.*
***** CAMPS ARE FOR FULL WEEKS or MINIMUM OF TWO DAYS ($40 per day) ONLY AND WILL BE FILLED ON A FIRST COME, FIRST SERVE BASIS. WE WILL EMAIL YOU BACK WITHIN 5 BUSINESS DAYS TO COMFIRM YOUR SPOT. ***** Camps are for Boys and Girls that are "RISING 1ST GRADERS TO GRADUATED 5TH GRADERS". All Camps are Mon-Fri 7:30am-5:30pm and are $175 per week.
- Week 1 - June 10th-14th (11th-The Block)
- >> 6/10 Mon - Trade Day - Firefighter
- >> 6/11 Tue - Field Trip - The Block
- >> 6/12 Wed - Discovery Day - Music
- >> 6/13 Thu - Discovery Day - Music
- >> 6/14 Fri - Fun Day - Water Day
- Week 2 - June 17th-21st (21st-Stone Mtn Hike)
- >> 6/17 Mon - Trade Day - Bee Keeping
- >> 6/18 Tue - Field Trip - Stone Mtn Hike
- >> 6/19 Wed - Discovery Day - Art
- >> 6/20 Thu - Discovery Day - Art
- >> 6/21 Fri - Fun Day - Lego Day
- Week 3 - June 24th-28th (25th-Lazy 5 Ranch)
- >> 6/24 Mon - Trade Day - Mobile Dairy
- >> 6/25 Tue - Field Trip - Lazy 5 Ranch
- >> 6/26 Wed - Discovery Day - Science
- >> 6/27 Thu - Discovery Day - Science
- >> 6/28 Fri - Fun Day - Wheels Day
- NO CAMP WEEK OF July 1st-5th
- Week 4 - July 8th-12th (9th-Mr Bounce w/ No Travel)
- >> 7/8 Mon - Trade Day - Law Enforcement
- >> 7/9 Tue - Field Trip - Mr Bounce w/ No Travel
- >> 7/10 Wed - Discovery Day - Sports
- >> 7/11 Thu - Discovery Day - Sports
- >> 7/12 Fri - Fun Day - Water Day
- Week 5 - July 15th-July 19th (19th NC Trans Museum)
- >> 7/15 Mon - Trade Day - Plumbing
- >> 7/16 Tue - Fun Day - Aviation Day
- >> 7/17 Wed - Discovery Day - Space
- >> 7/18 Thu - Discovery Day - Space
- >> 7/19 Fri - Field Trip - NC Trans Museum
- Week 6 - July 22nd-26th (23rd-Cookie Factory)
- >> 7/22 Mon - Trade Day - Chef
- >> 7/23 Tue - Field Trip - Cookie Factory
- >> 7/24 Wed - Discovery Day - Cooking
- >> 7/25 Thu - Discovery Day - Cooking
- >> 7/26 Fri - Fun Day - Christmas in July
- Week 7 - July 29th-Aug 2nd (30th-Discovery Place)
- >> 7/29 Mon - Trade Day - Robotics
- >> 7/30 Tue - Field Trip - Discovery Place
- >> 7/31 Wed - Discovery Day - Language
- >> 8/1 Thu - Discovery Day - Language
- >> 8/2 Fri - Fun Day - Aloha Day
Parent or Guardian Information
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Emergency Contact Name 1:*
First Last
Emergency Contact Relationship 1:*
Emergency Contact Phone 1:*
Emergency Contact Name 2:*
First Last
Emergency Contact Relationship 2:*
Emergency Contact Phone 2:*
Medical Information
Does Your Child Have Allergies?*
- Yes
- No
If Yes to Allergies please specify
Any special needs?
Name of Person Giving Permission for Medical Attention*
I give permission for my child to receive medication and emergency treatment in the event of illness or accident. I give the person(s) designated by South River Baptist Church, to be a leader or chaperone for this camp, permission to make a decision concerning emergency treatment.
First Last
Medical Insurance Carrier*
Medical Insurance Policy Number*
Medical Insurance Card Upload*
Max. file size: 512 MB.
Discipline
Name of Person Giving Permission for Discipline*
I would like to inform the leaders of this Summer Camp that I fully trust their judgments and decisions toward the well being of my child. I trust my son/daughter to adhere and abide by any and all rules set forth and decisions made by the counselors. If my child does not, I expect them to be disciplined without the use of physical force as deemed necessary by the person(s) designated by South River Baptist Church to be counselor/chaperone for this event.
First Last
Liability Release
Name of Person Giving Liability Release*
I hereby release South River Baptist Church, their staff, chaperones and counselors of any and all liability in the event that my child is injured or becomes ill while in their care.
First Last
Name of Person Giving Transportation Liability Release*
I am fully aware that my child will be transported to and from activities based on days and weeks registered and that there will be ample supervision. I understand in the unlikely event of an accident or emergency that my child will receive adequate care based upon the information given. I assume all risks, hazards and incidentals involved in the conduct of the activity. I do hereby release, indemnify and hold harmless Headwaters Christian Academy and South River Baptist Church from any and all loss, injury or other damage arising out of this activity. I understand that the child will be transported to and from the offiste activity and I also understand the inherent risks in any travel, and agree to waive any and all liability on behalf of the referenced organizations for those risks.
First Last
Misc Information
I have read and agree to the information provided in the Summer Camp Handbook*
Here's the link to the Summer Camp Handbook https://southriverbaptist.com/wp-content/uploads/2024/03/2024__summer_camp_handbook.pdf
- Yes
I understand that images of my child may be captured and used through video, photo and digital camera, to be used solely for the purposes of promotional material and publications, and I waive any rights of compensation or ownership thereto.*
- Yes
Name of person registering child for Summer Camp*
Email of person registering child for Summer Camp*
Signature of person registering child for Summer Camp*
Do you have a church home?*
- Yes
- No
If Yes, where?
Is your child a student at Headwaters?*
- Yes
- No

Like this:

Like Loading...

Manage Cookie Consent

To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent, may adversely affect certain features and functions.

Functional Functional Always active

The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.

Preferences Preferences

The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.

Statistics Statistics

The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.

Marketing Marketing

The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.

View preferences

{title} {title} {title}

%d

Child's Information

Parent or Guardian Information

Medical Information

Discipline

Liability Release

Misc Information

Share this:

Like this: