Camp Kidz Quest Registration
Please complete form.  After you complete the form, you will receive an email whether your child is enrolled in the camp or on the waitlist.
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Email *
Which Week(s) Are You Registering For? *
Required
Child's Name *
Child's Age *
Child's Grade They Just Completed *
Child's Shirt Size *
Name of Parent/Guardian *
Address *
Email Address *
Parent/Guardian's Phone Number *
Church Affiliation *
Emergency Contact *
Emergency Contact Phone Number *
Allergies or Medical Condition Kihei Baptist Chapel needs to be aware of. *
Is the child covered under family medical insurance? *
If yes, indicate carrier or provider.
Name of primary insured
Insurance ID Number
If student is under 18 Parent/Guardian Authorization:I give permission to Kihei Baptist Chapel staff to administer basic first aid to my child.  I also give permission for KBC staff to seek emergency medical treatment including ordering x-rays or routine tests.  I agree to the release of any records necessary for insurance purposes.  I give permission to the KBC staff to arrange necessary related transportation for my child.  In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by KBC staff to secure and administer treatment for my child.  *If you agree type name below. *
RELEASE FOR MINOR CHILDREN I hereby grant permission to Kidz Quest, its employees or representatives, to take and use: photographs/digital images, video,  or quoted remarks of my child for use in Kihei Baptist Church’s promotional or educational materials. If agree, type name and date. *
I understand that drop-off is 8:30AM and pick-up is 12:00PM.I understand that my child will be asked to wear a mask as much as possible.I understand that I may not send my child to the program if they are sick and if they become sick while at the program, they will be sent home immediately.I understand that my child will have his or her temperature checked upon arrival each day and if my child’s temperature is 100 and above, they will not be allowed to return to the program without a doctors note.I understand that I will not be allowed in the facility during the program, including pick-up and drop-off (unless I have arranged in advance to volunteer).  If the child needs to be picked up early, I will contact the church so they can bring my child to the pick-up location. Please type your name that you have read and understand the above statements. *
Given the COVID-19 environment, the Kihei Baptist Chapel (KBC) is requiring all students participating in the Kidz Quest Program to adhere to the following safety guidelines and provide the below information in order to reduce the risk or spread of infection. Parent(s) or guardians must acknowledge the following statements to participate in the program at KBC. ____ My student has not had contact with anyone confirmed with COVID-19 in the past 14 days. At any point in the future, if I have reason to believe my student has come into contact with someone with COVID-19, I agree to immediately notify KBC staff and keep my student at home. ____ My student is not currently experiencing a fever over 100, difficulty breathing, sore throat, cough, loss of taste, or headache. At any point in the future, if my student has any of these symptoms, I will notify KBC staff immediately. I agree to not allow my student to participate in any summer programming with these symptoms and will wait at least seven (7) days after symptoms have subsided to return to training or provide KBC with a COVID-19 negative test confirmation. ____ My student has not had any of the following symptoms in the last 14 days: fever greater than 100 degrees, difficulty breathing, sore throat, cough, loss of taste, or headache. ____I have read the information and answered the questions above to the best of my ability. I agree to continue to adhere to the above safety guidelines as long as my student participates in the Kidz Quest Program. Assumption of Risk and Waiver of Liability Relating to COVID-19 The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. However, there remain many unknowns about COVID-19, how it spreads, and its impact on a student. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Kidz Quest Program.  On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Kihei Baptist Chapel, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.  Please type your name and date that you have read and acknowledge the above statements.   *
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