Registration for FREE "Treasured" Kids Camp
@ Beacon Falls Congregational Church
69 Wolfe Avenue, Beacon Falls, CT 06403

Monday July 15th thru Friday July 19th, 2024
9:00AM to 12:00PM

For Children Ages 4 through 11

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Email *
Camper #1 Name (First & Last) *
Camper #1 Date of Birth *
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What was Camper #1's grade in the 2023-2024 school year? *
Does Camper #1 have any allergies or health concerns that we should know about? Please list or indicate N/A. Will any medications need to be administered while at KIDS CAMP? *
Camper #2 Name (First & Last)
Camper #2 Date of Birth
MM
/
DD
/
YYYY
What was Camper #2's grade in the 2023-2024 school year?
Clear selection
Does Camper #2 have any allergies or health concerns that we should know about? Please list or indicate N/A. Will any medications need to be administered while at KIDS CAMP?
Camper #3 Name (First & Last)
Camper #3 Date of Birth
MM
/
DD
/
YYYY
What was Camper #3's grade in the 2023-2024 school year?
Clear selection
Does Camper #3 have any allergies or health concerns that we should know about? Please list or indicate N/A. Will any medications need to be administered while at KIDS CAMP?
Parent/Guardian's Name (First & Last) *
Parent/Guardian's Best Contact Phone # *
Parent/Guardian's Best Contact Email Address *
Parent/Guardian's Home Mailing Address *
Who else (beside the above listed parent/guardian) has permission to pick up your child(ren)? Your child(ren) will only be dismissed to those named below! (please make sure these people have photo IDs at pick up)
Special Request(s) or other important information we should know:
I authorize and give my permission for my child/children to participate in Beacon Falls Congregational Church Kids Camp 2024. I understand they may be participating in various activities and that there are risks associated with that. I give my consent to the use of any video or photography by the volunteers to share within Beacon Falls Congregational Church, omitting names, and release Beacon Falls Congregational Church from any liability connected with the use of multimedia in which my child appears. Please sign below (I understand that typing my name electronically is the same as a signature): *
A copy of your responses will be emailed to the address you provided.
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