Kamper's Name

First Name

Last Name

Birthdate

YYYY

Gender

Shirt Size

Daytime School Attending

Current Grade In School

Guardian 1

First Name

Last Name

Email Address (Guardian 1)

Physical Address (Guardian 1)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address (Guardian 1)

If different than physical address

Cell Phone (Guardian 1)

(###)

###

####

Work Phone (Guardian 1)

(###)

###

####

Guardian 2

First Name

Last Name

E-mail Address (Guardian 2)

Physical Address (Guardian 2)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address (Guardian 2)

If different than mailing address

Cell Phone (Guardian 2)

(###)

###

####

Work Phone (Guardian 2)

(###)

###

####

Physician's Name and Phone Number

Allergies/Dietary Restrictions

If none, please type "N/A"

I authorize the persons listed below to pick-up my child from Kinder Kamp. (Photo ID will be required)

Please tell us about your child. Helps us get to know them to be sure we can meet their needs.

(Allergies, hobbies, favorite activities, pets, special assistance required, physical impairments, behavior challenges, etc.)

Services Needed

Please click all services you are registering for.

Session 1: June 3rd- June 14th: Swimming Lessons (added cost)

Session 2: June 17th - June 28th: Brooke Miller Equestrian & Rylan Ranch Petting Zoo

Session 3: July 8th- July 19th: Premier Lanes Bowling & Safari Schoolhouse Reptile Encounter

Session 4: July 22nd- August 2nd: Planet Ice & Water Day

New Member 2023

NEW MEMBER enter today's date/If you are already a member list date membership became active for 2023

YYYY

Authorization

I authorize Kinder Kollege's Kinder Kamp to secure emergency medical treatment for my child.

I hereby give my permission for all children listed above to ride a van or bus from the school(s) listed above to Kinder Kollege or Kinder Kamp and to participate in our after school program.

I acknowledge that there exists the potential of a motor vehicle accident while my child or children are being transported while under the care of Kinder Kollege or Kinder Kamp.

I assume any healthcare expenses relating from any such accident, illness or other incapacity which may occur while my child or children are being transported under the care of Kinder Kollege or Kinder Kamp.

I further understand that by signing this permission slip, I release and hold harmless Kinder Kollege and Kinder Kamp, its officers, employees, and any volunteers from any liability or damage related to my child riding a bus or van to/or from Kinder Kollege or Kinder Kamp.

Name

First Name

Last Name

Kamp Membership

As a member of Kinder Kamp, our kampers are given access to many opportunities. They may choose to participate in our Holiday program and/or Summer Kamp! To participate in these extra-curricular activities, Kampers must first become a member by annually completing the initial registration form. Once registration has been received, within 48 hours, you should receive an invitation via email, to Smartcare, our online billing system. Once link is opened the Smartcare account can be complete. This program will give access to our clock in/out system as well as our billing platform. Membership will be in affect once the annual fee of $115 has been paid in full and all spots requested will be reserved. Please click on the navigation tabs above for more information!

Registration

Kamp Membership

Kinder Kamp Registration