ROAR Adventure Camp Registration

Warning!

This form cannot be submitted until an administrator completes the setup process to receive online payments.

Registration Information

Use this form to register 1st - 5th grade campers.

Child's Name

Parent/Guardian First and Last Name

Address

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Contact Phone

Would you like to receive text message notifications from camp? Yes, I want to receive text notifications

Cell phone number to receive text message notifications from camp

By checking this box, you are opting in to receive text messages from ROAR Summer Adventure camp. This will be used for important camp information and updates. Messaging rates/fees may apply.

Child's Gender

Female Male

Child's Date of Birth (MM/DD/YYYY)

Grade Entering in Fall 2019

Child's T-Shirt Size (we can only guarantee a t-shirt for campers registered by June 7)

Allergies or Medical Concerns?

Emergency Contact & Alternate Pick-Up Information

Please provide a person to contact in case of emergency and an Alternate Pick Up if someone other than the Parent/Guardian will be picking up your child.

Emergency Contact First and Last Name

Emergency Contact Relationship

Emergency Contact Phone

Alternate Pick Up First and Last Name

Alternate Pick Up Relationship

Alternate Pick Up Phone

Medical Release

In the event that I, and any emergency contacts listed on my child’s Registration Form, cannot be reached in an emergency, I hereby give permission to the physician selected by the Camp Director to provide necessary medical treatment, including anesthesia or surgery, for my child. I also release, and agree to hold harmless, Church of the Resurrection, and all its participants, from any liability, and assume all risk of injury, damage, or expenses as the result of participation in activities at ROAR Adventure Camp.

I agree to the above Medical Release.

Please type full name as electronic signature:

Photo Release

I understand that, as a participant in Church of the Resurrection’s ROAR Adventure Camp, my child may be photographed or recorded on video/audio during camp events, and that these may be used in presentation or promotional materials.

Permission to Photograph/Video Record:

I AGREE to have my child photographed/ video recorded. I DO NOT want my child photographed/ video recorded.

Please type full name as electronic signature:

Additional Information

Friend you would like to be placed with (if applicable):

Additional comments/questions?

Camp Fee

Please select the appropriate fee below. Payment can be mailed by check or cash to Church of the Resurrection 11525 Greenspring Avenue, Lutherville, MD 21093. **Please write "Summer Camp" on the memo line, and include a note saying which child(ren) the fee is for.**

Camp Fee

Registration - $95 per child Max per Household - $200 I would like to request a scholarship; please contact me. Camp Volunteer (There is no fee for your child to attend if you will be volunteering the week of camp!)

Payment

- Registration Rates: $75 early registration; After May 1: $95/child; $200/ Families with 3+ children. - For families with 3+ children who are paying online please select "Family" Option $200 for first child and check "Family Discount" $0 for subsequent children. - Camp Fee waived for children of camp volunteers and church staff - If you are mailing a check, please put children's names in the memo. - If you requested a scholarship, select the 'Mail Check' option and we will be in touch with you about a scholarship.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

ROAR Adventure Camp Registration

Description

Please Fix the Following