VVKids Camp Waitlist

* Child First Name

* Child Last Name

* Child Email

* Child Birth Date

* Child Gender

* Child Grade (Current)

Child Current School (College Age and Under Only)

* Name(s) of Parent(s)/Guardian(s) (Please list name of parent(s) and cell (or best) contact number (s) )

* Emergency Contact Name 1

* Emergency Contact Phone 1

Emergency Contact Name 2

Emergency Contact Phone 2

* Child T-Shirt Size

* Child Allergy & Medical Concerns

Physical Limitations (Please list any health concerns or physical limitations we need to be aware of)

Church You Attend

Roommate Requested

* I grant permission to Valley View Church the right to use, reproduce, and/or distribute media of my child, without compensation, for use in promoting the activities of the church. Do you agree to the above media release?

Special Notes/Requests

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