Camper Registration

In Case of emergency, contact:
Kids of Victory – Summer 2015
Campers Registration Form
Name:
This form is for Children who have completed Kindergarten
(and are 6 by Aug. 1, 2015) through 6th grade.
First Name:
Relationship to child:
Day Time Phone #:
Last Name:
Is your child an independent swimmer?
Yes No
(No = your child requires one on one assistance)
Nick name or name you want printed on t-shirt
Age:
on August 1, 2015
Circle
Male
Female
Please Print Clearly
Grade COMPLETED Spring 2015
Mother’s
First Name:
Father’s
First Name:
Allergies:
All Medications your child is on:
Last
Name:
Last
Name:
Special Needs Considerations:
Address:
City, State & Zip:
My child:
Home Phone #:
Child’s Name
Mother’s
Cell #:
Father’s
Cell #:
Email:
Email:
Home Church:
Is this your first year at KOV? Yes
T-Shirt Size - Circle One (1)
Child
Child
Child
Adult
6-8
10-12
14-16
S
Adult
M
No - I’ve attended
Adult
L
Adult
XL
years
KOV T-shirts cannot be cut or
changed during camp.
has permission to participate in all Kids of Victory - 2015 events and field trips. I
give my consent for my child to be photographed as a part of KOV programming
and nonprofit promotions.
In the event that my child needs medical attention during Kids of Victory – 2015, I
give permission for Ministry Staff to administer medical treatment or admit to a
hospital for emergency treatment. I further agree to hold harmless and release
from liability Southgate Church, its ministers, and anyone acting on behalf of KOV
for any and all injuries sustained while at KOV.
Date:
Parents or Guardians Signature
Attendance is limited to one week only.
Circle the week you wish to attend.
Session 1:July 13-17
Session 2: July 20-24
Session 3: July 27-31
Requesting team placement to be with a friend is not guaranteed, but we will try our best to
honor one single request, received by May 31. Both campers must request each other.
Listing multiple names will result in no friend placement. Campers cannot be placed with
teen leaders, except for medical reason.
Friend’s
Friend’s
First Name:
Last Name:
 **My child has disabilities and I would like for him/her to be in the Special
Class Room that will be during Session 1 - July 13-17.
www.kidsofvictory.org and/or ‘Like’ us on facebook
:
ST
CO
Early Bird Prices
$55 if registered by April 20*
$65 if registered by May 31
$75 for all registered after May 31*
*NO refunds can be issued after June 10!
Make checks payable to: Southgate Church
Mail to: Kids of Victory
9820 East Watson Road, Crestwood, MO 63126
314-842-8679
**We have always been open and accepted children with disabilities. To reach out to children
with more severe disabilities, this year during Session 1 - July 13-17, we are opening a special
room to accommodate children who cannot tolerate the noise and fast pace of KOV. This selfcontained room will teach the same lessons, crafts, and games in a quieter, calmer environment.
This room will be staffed with trained professionals as well as trained adult and teen volunteers.
Deadline to register for this week is May 31.