Mega Sports Camp Registration • Warren C&MA Church

Choose Event *

There are currently no events available for registration.

Child's Information

First Name *

Last Name *

Mailing Address *

Mailing City *

Mailing State *

Mailing Zip Code *

Gender

Date of Birth *

Age *

Last School Grade Completed *

All Pre-K kids (4 & 5 year olds) will be in our Sports Basics program which includes various age appropriate activities and games.

Which sport would you like to participate in? *

Parent/Guardian Information

Parent/Guardian Name *

Best Phone *

Email Address

Emergency/Medical Information

Emergency Contact Name (1) *

Emergency Contact Phone (1) *

Emergency Contact Name (2)

Emegency Contact Phone (2)

Special Concerns (allergies, medications, medical conditions, etc.)

Health Insurance Company

Policy Number

Primary Care Physician

Primary Care Phone

Authorizations

I grant to Warren Alliance Church and its representatives the right to take photographs of my child in connection with Mega Sports Camp. *

I agree that Warren Alliance Church may use such photographs of my children with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. *

In case of an emergency, I authorize first aid and/or medical treatment for children listed. I release Warren Alliance Church from any and all responsibility in connection therewith. *

Permission and Release

I hereby give my permission for the child/ren listed to participate in any activities associated with Mega Sports Camp at Warren Alliance Church (WAC). I understand that these child/ren will be under adult supervision. I further understand that in signing this form, I release and hold harmless WAC and all its trustees, officers, employees, interns, and any volunteers from any liability, past or future, fully and completely.

Parent/Guardian E-Signature *

Today's Date *