Camp-Out Kid’s Assembly
Dear Parents,
I am excited for Kid’s Assembly this year. Nursery is available for infant through age three. Kid’s Assembly invites children ages four through fifth grade (graduating). There is no cost.
At Camp-Out Assembly, kids will discover that Jesus is the light of the world through a relatable, outdoorsy camping adventure! This Kids Assembly is filled with incredible Bible-learning experiences kids see, hear, and touch. Team-building games, cool Bible songs, and multisensory Bible adventures are just a few of the activities that help faith flow into real life! Its everything camping- Minus the bug spray and lack of sleep, oh and adding a LOT of water! Don’t forget to bring your swimsuit!
We have the awesome opportunity to enjoy an on-site water park!! The kids will have a blast in the 20,000 sq. feet of water fun. The water park is for kids age five to 5th grade. Those students will need a water park pass. Four and younger will stay in the nursery room. I am looking forward to this time with the students. I am praying that their relationship with God deepens and they will create great friendships with each other, all while having a blast! Below is my email and cell number. Please let me know if you have any questions or concerns. Please fill out the attached forms and bring them on the day of the event or mail them to Racine Community Church.
Pastor Kathryn Larrabee
262-902-3062
Racine Community Church 8440 Spring St. Racine Wi, 53406
Wisconsin Kids Assembly 2017 Registration
Child’s Name: ______
Birthday: ___/___/_____ M__ F__ Age___ Grade Entering:______
Address:______
City/State/Zip:______
Parent(s)/Guardian(s): ______
Phone: (___)______Evening: (___)______Cell: (___)______
Home Church: ______
I give my permission for any pictures of my child taken during Assembly to be used for promotion: Yes___ No___
Medical Information
Family Physician:______Physician Phone (____)______
Health Insurance Company: ______
Policy Number: ______
Date of last tetanus booster: ______
Allergies: ______
Medical Conditions: ______
Special Care Needs: ______
Current Medications: ______
Please note that we will be unable to administer any medicines. Parents/Guardians will need to make arrangements in order to do so themselves.
Emergency Contact Information
Name: ______
Relationship to child: ______
Phone: (____)______
This application is complete and accurate as far as I know. I hereby give permission for the child above to participate fully in the program except as noted on this Registration Form. In the event of illness and injury, I also give permission for the doctor, dentist, or other health professionals selected by Kids Assembly director to order such tests and treatments as is deemed necessary to safeguard the health of my child. In the event I cannot be reached in an emergency, I authorize the physician selected by the Kids Assembly director to hospitalize, secure proper treatment and order injections and/or surgery for the child named about. I waive any and all claims against the Wisconsin District Church of the Nazarene, any of its committees/boards, or its representatives or property in connection with an incident of the 2014 Wisconsin District Kids Assembly Program. I understand that any and all emergency medical expenses are my responsibility. My child and I understand that failure to comply with Kids Assembly rules and/or obey staff directives is cause for dismissal and I will be asked to remove my child from Kids Assembly.
______
Parent/Guardian’s Signature, Date
Water Park permission slip (ages 5 to 5th grade)
The Springs Water Park
2810 Golf Road, Pewaukee WI 53072 (on-site)
Please drop off your student in the Kid’s Assembly room and pick up your student in the water park area.
Monday, July 24th. Afternoon session
_____ Yes, my child can participate and join the group!
_____ No, my child will not be able to go to the water park.
If your child is not participating in the afternoon activity, you will need to keep your child with you.
______
The Springs Water Park
Please drop off your student in the Kid’s Assembly room and pick up your student in the water park area.
Tuesday, July 25th. Afternoon session
_____ Yes, my child can participate and join the group!
_____ No, my child will not be able to go to the water park.
If your child is not participating in the afternoon activity, you will need to keep your child with you.
______
The Springs Water Park
Please drop off your student in the Kid’s Assembly room and pick up your student in the water park area.
Wednesday, July 26th 9:00am- 12:00pm
_____ Yes, my child can participate and join the group!
_____ No, my child will not be able to go to the water park.
If your child is not going to be able to participate in the water park trip, you will need to keep your child with you.
______
Parent’s Name______
Parent’s signature______
Parent’s cell number______
Please note: Parents will be called to come pick up their child if there are any behavior problems while we are at the water park.