Please check your size
* 1st camp shirt is included in your activity fee and each additional shirt is $10.00
Medical Release Information
I give permission for the camp staff or emergency care personnel to administer first aid or medical treatment in the event of an emergency involving my child.
I hereby authorize Abyssinia Missionary Baptist Church Summer Camp to transport my child for all summer camp field trips/activities . Should travel take place by vehicle, the driver shall hold a current driver's license and the vehicle will be registered and insured according to the state law.
I hereby give permission for my child to be photographed during the Camp AB Summer Camp. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Camp AB Summer Camp and its affiliates.
I give consent for my son/daughter’s school records, and after school/camp applications to be accessed by Kids Hope Alliance staff for the purpose of monitoring and gathering data for the analysis of program effectiveness.
I hereby give my child permission to participate in the Abyssinia Baptist Church Summer Camp Program. I understand that the Abyssinia Baptist Church is not responsible for any accidents or injuries unless there is negligence on their part.
In consideration for the privilege of allowing my child to participate in the above-named activity, I agree to release and hold harmless the Church, its officers, and agents, from any liability to or responsibility for bodily injury, damage or illness to the above-identified child while participating in any youth athletic or social activity which may be directly or indirectly sponsored by the Church. Further, I agree to indemnify and hold harmless the Church, its officers and agents with respect to any claim asserted by or on behalf of my child as a result of bodily injury, illness, or damage.
There is a $150.00 non-refundable deposit to secure a spot for your child at Camp AB which does go towards your camp balance. In the event of cancellation, your deposit will not be refunded. If your child misses a day or more during the week, there is no deduction of fees. I also acknowledge if my student attends extended day that fess are due Monday morning of each week.
Payments accepted in cash, credit cards, online, or certified money order (NO CHECKS)
ENTER CAMPER’S INFORMATION
First Name *
Last Name *
Home Address1 *
Address 2
City *
State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMinor Outlying IslandsMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasU.S. Virgin IslandsUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip *
Phone *
Grade *
Date of Birth *
Age *
Gender * MaleFemale
CAMP SHIRT INFORMATION
Select shirt size from Youth or Adult sizes below.
Youth Shirt Sizes Select Youth SizeYXSMYSYMYLYXL
Adult Shirt Sizes Select Adult SizeASAMALAXLAXXL
PARENT CONTACT INFORMATION
Parent First Name *
Parent Last Name *
Relationship to Camper *
Mailing Address 1
Mailing Address 2
Home Phone *
Cell Phone *
TERMS OF AGREEMENT
Please read and accept each section of the Terms of Agreement
Photo Release: Check to Accept *
Kid’s Hope Alliance Consent: Check to Accept *
Parent/Guardian Signature (Please enter full name below.) *
