REVOLUTION CAMP 2016 REGISTRATION
CAMP SELECTION
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BOTH Sports & Performing Arts Camps ($40)
ONLY Sports Camp ($30)
ONLY Performing Arts Camp ($30)
Youth's Information * = required
First Name
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Last Name
*
Email:
Birthdate
Male
Female
Grade in school next fall
Referred By:
Street Address:
City:
Zip Code:
T-Shirt Size
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Parent/Caregiver's Information
First Name
*
Last Name
*
Phone:
*
Email:
*
Emergency Contact if parent can't be reached (Name, Relationship, Phone)
Hospital
Known allergies or other medical concerns:
Do you have a home church that you regularly attend??
Yes
No
If yes, name of your church:
RELEASE: I hereby release and agree to hold harmless First Baptist Church of Champaign at Savoy (FBC-CS) and designated leaders from all liability for damage, illness, or injury. In case of emergency, I give my permission for any necessary medical treatment. I will not hold FBC-CS or any leader/staff persons responsible for any injury that may occur.
I also give my permission to FBC-CS to use photos of my children, without any identification, in publications and/or on their website for promotional purposes.
*
Yes, I Agree
Registration is not complete until payment is made.
Security Code
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