Your Child's Information
*One form per child please

Child's First Name

Child's Last Name

Child's Gender

Child's Birthdate (mm/dd/yyyy)

Grade (Going into)

Child's T-Shirt size
Youth SYouth MYouth LYouth XLAdult SAdult MAdult L

Will you be attending all of the days?
YESNO

If no, which days will you be attending?

Medical Conditions?
YESNO

If yes, please describe.

Allergies?
YESNO

If Yes, please describe.

Any other information that would be helpful for us to know about your child?

Parent or Guardian's Contact Information

Parent or Guardian's First Name

Parent or Guardian's Last Name

Address 1

Address 2

City

State

Zip Code

Phone Number

Secondary Phone Number

Email Address

Another parent or guardian that is allowed to pick up the child?

Do you regularly attend church?:
YESNO

If yes, which church are you a part of?:

*I understand that by signing below that I give permission for my child (listed above) to participate in Camp Discovery sponsored by The Gate Church, including photographs or videos that may be shared on the church's website or social media page. I understand there is always risk in any activity, and I will not hold The Gate Church liable for any accident or injury that might result from my child's participation in this camp.
YES, I understand.

Parent's Signature (type your full name as signature)

Today's Date