Summer Day Camp Registration Form 2026 (Ages 5-12)

General Information

Day Camp will be running from July 13-17th from 9 AM-12 PM
(Ages 5-12) (Kindergarden to Grade 6)

Only one child can be registered at a time.

Early-bird fee: $60.00 per child. (Ends May 25th)
Regular rate: $70.00 per child. (Registration closed July 5th)

Child's Name

Parent/Family/Guardian Name

Address

This address will receive a confirmation email

Cell Phone

Home Phone

Work Phone

Child's Birthdate

Child's Age

Last Grade of School Completed

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

Home Church (if any)

How did you hear about our camp?

Do you want your child to be in the same group as anyone specific?

Are there any medications we should know about that your child will use at camp?

Are there any allergies we should be aware about?

Is your child neurodivergent? If yes, please explain:

Incase of an emergency, please provide your child's healthcare#

Info to Protect Your Child

Contact #1: First and Last Name

Contact #1: Phone Number

Contact #2: First and Last Name

Contact #2: Phone Number

Name(s) of person(s) who may pick up this child from VBS

Photo Release

By checking the YES box I give Gospel Centre Church permission to use my child's photograph publicly in Day Camp materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media.

Do you consent?

Yes No

Release of Liability

I/We, the parents/guardians named above, authorize the ministry staff of Gospel Centre to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the child named above. I/We, named above undertake and agree to indemnify and hold blameless the ministry staff, Gospel Centre, its pastors and board of elders from and against any loss, damage or injury suffered by my child as a result of being part of the activities of Gospel Centre, as well as any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of Gospel Centre. By checking one of the boxes below and typing my name below, I am electronically signing this consent form.

I consent:

Yes

Parent/Guardian's Signature

Date

Payment 60 CAD

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Summer Day Camp Registration Form 2026 (Ages 5-12)

Description

Please Fix the Following