Summer Camp-KINGDOM K.E.Y.S. MEN

Summer Camp

Their is a $40 registration fee for every camper enrolled.

Child's First Name

Child's Last Name

Parents Name

Address

Phone Number

Age

Birthday

Gender

Male

Female

Emergency Contact Name #1

Emergency Contact Phone Number #1

Relationship

Emergency Contact Name #2

Emergency Contact Phone Number #2

Relationship

Does your child have there allergies, things they are allergic to, or any other medical issues that we need to know about? Parents please leave us with any prescribed medication or inhalers.

Pick-up | Adults other than a parent. The following people may pick up my child from aftercare: Adults other than the parents must provide ID when picking up the child.

Pick up #1

Relationship

Pick up #2

Relationship

Choose the option that is best suited for your needs.

Summer Camp $65 a week 8am-3pm

Aftercare $20 a week 3pm - 5pm

Parent/Guardian Consent I request that the child named on this registration form be admitted to the designated Kingdom KEYS Mentoring after school program. Acceptance is at the discretion of K.E.Y.S Aftercare program. I hereby give my consent for my child to participate in any of the after school program activities sponsored by Kingdom KEYS Mentoring, and all personnel associated with the program shall not be held liable for any injury whatsoever my child may sustain in the activities thereof. I also certify that I know of no physical problems or conditions of my child which would impair participation in the program. I authorize the person in charge to secure first aid and/or the services of any legally qualified physician or hospital, and agree to assume all financial obligations. Parent's signature is required below.

Your Signature

MEDIA RELEASE FORM I hereby grant to Kingdom K.E.Y.S. Mentoring, their successors, and their assignees the right to record the image and/or voice and use the artwork and/or written work of my child on videotape, on film, on photographs, in digital media and in any other form of electronic or print medium and to edit such recording at their discretion. I understand that my child’s full name, address and biographical information will not be made public. I further grant Kingdom K.E.Y.S. Mentoring, their successors, and their assignees the right to use, and to allow others to use, my child’s image and/or voice on the internet, in brochures, and in any other medium and hereby consent to such use. I hereby release Kingdom K.E.Y.S. Mentoring , their successors, and their assignees and any using my child’s image and/or voice, artwork, and/or written work pursuant to this media release form any and all claims, damages, liabilities, costs and expenses which I or my child now have or may hereafter have by reason of any use thereof. I understand that the provisions of this release are legally binding.

Your Signature

Summer Camp

Pick-up | Adults other than a parent. The following people may pick up my child from aftercare: ***Adults other than the parents must provide ID when picking up the child.***

Pick-up | Adults other than a parent. The following people may pick up my child from aftercare: Adults other than the parents must provide ID when picking up the child.