2022 Kid's Camp 'Boundless' Registration Form
Please complete this form below to register your 4 year old thru rising 6th grader for Kid's Camp July 18-21.

Due to COVID-19 precautions, pre-registration and health questionnaire is required to attend.

**Please Note** A final in-person signature/form will be required at drop-off first night.

Once you register, you will receive a confirmation email. Contact Pastor Jared Stine 336-804-4124 (text/call) or email rev.jared.stine@gmail.com with any questions/concerns.

All activities will take place at Columbia Falls United Methodist Church 117 2nd St West, Columbia Falls, MT 59912
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Parent/Guardian Name *
Parent/Guardian Email (this will be the primary contact method) *
Address (w/ city, state, and zip) *
Phone number (best # to contact you) *
Child's full name, age, and grade entering (ex. Jared, 8, 2nd) *
Additional children, age, and grade entering
Additional children, age, and grade entering
Your family is invited to dinner each evening from 5:15-5:45p. While we know you may not come every night, how many should we include in our count to prepare dinner, including your Kid's Camp kids? (write NO if not planning to attend dinner) *
Allergies - any food allergies in your family for which we can prepare?
Emergency Contact Name and phone number *
Emergency Contact relationship to child *
Insurance Company, Policy #, and company phone # *
Child/children Health History: Any special concerns or recurring illness? (answer "no" if none) *
Specific activities to be limited
current medication or medical treatment
All immunizations required for school are up to date *
Explain immunization
Date of last Tetanus
Dietary concerns/allergies?
Allergic to penicillin, bee stings, or anything else? (please specify)
Anything else camp staff should be aware of to better care for this/these child/children?
Parent/Guardian Emergency Medical Treatment Approval *
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Signature: Please type full name (by typing full name and submitting registration, you agree to all submissions in this form) *
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