Kid City Camp 2026 Registration

* First Name

* Last Name

* Parent/Guardian Name (first and last)

* Email

* Cell Phone Number

* Address

* Child's Age

* Allergies

* Activity Choice 1

* Activity Choice 2 (This will only be used if Choice 1 is full)

* Authorized pickup other than Primary Parent/Guardian

* Authorized Pickup Phone Number

* Have you attended Kid City Camp in past? If so, have many times?

* How did you hear about us?

* Do you authorize your child to be in pictures we take during the camp week? (children not authorized will be given a bracelet to wear)

Release Form

I, the undersigned parent/guardian, do hereby grant permission for my son/daughter, named above, to attend camp. In order for my child to receive treatment in the event that he/she may sustain injury or illness during Vineyard Life Church Kid City Camp, I hereby authorize the staff of Vineyard Life Church to obtain medical treatment for my child for such injury or illness during camp, and I hereby hold the staff and volunteers of Vineyard Life Church and sponsoring organizations, harmless in exercise of this authority. I further understand that there is always a possibility that my child may sustain injury while at camp. If this occurs, I hereby authorize the staff of Vineyard Life Church to refer my child to a medical treatment center, if they are unable to get a hold of me. I further acknowledge and understand that I will be held responsible for any medical bills that may be incurred. I authorize Vineyard Life Church to take pictures of my child participating in Vineyard Life Church Kid City Camp. I give permission to use the photos in any promotional material. By signing below you, you agree to these terms.

* Parent Guardian Signature