Redeemer Covenant Church Kids Ministry 2017 Kids In Action Day Camp Registration (Kinder – 6th grade) Please complete one form per child
June 26th – 30th 8:30 am – 12:00 noon $30 per child for the week ($5 discount for additional siblings) Please drop off or mail registration form, along with payment to: Redeemer Covenant Church. 6800 Main Avenue, Orangevale, CA 95662 Child’s First Name _____________________________________ Child’s Last Name _______________________________________ Birth Date ________________________________________ Age _________________
Girl [
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Boy [
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Address ____________________________________________________________________________________________________ City ___________________________________ Zip _______________
Circle T-shirt size: YXS YS YM YL YXL AS AM AL
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Father/Guardian Name _____________________________________________ Cell Phone _________________________________ Mother/Guardian Name ____________________________________________ Home Phone _________________________________
Cell Phone _________________________________
Other Phone _________________________________
Email ______________________________________________________________________________________________________ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you can not be reached during the hours of Kids In Action, please indicate emergency contact: Name ______________________________________________________________ People authorized to pick-up your child during this camp Does your child have any allergies? Y [ ]
N[ ]
Phone _________________________________
_____________________________________________________________
Please explain:______________________________________________________
How did you hear about the Redeemer Kids in Action Day Camp? _______________________________________________________ Are there any conditions that we need to be aware of?_________________________________________________________________ ____________________________________________________________________________________________________________
I understand that no refunds will be given within two weeks of camp start date: Initials _________________ Grade entering in the fall:
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☐ Kinder ☐ 4th Grade
☐ 1st Grade ☐ 5th Grade
☐ 2nd Grade ☐ 6th Grade
☐ 3rd Grade
Child’s First Name ___________________________________ Child’s Last Name __________________________________________
Kids in Action Specialized Activities Your child will participate in two Specialized activities during Kids in Action Day Camp. These activities will take place every day of camp. Please rank 1st, 2nd, 3rd, 4th, 5th and 6th choice for activities. We will do our best to accommodate all students, however, some class sizes are limited. _____ Beginning Piano
_____ A Sport a Day Can’t pick one? Play all the sports throughout the week
Learn piano basics & play a song at the end of the week
_____ Acting through Skits
_____ Beginning Ukulele
Practice and prepare daily skits
_____ Acrylic Paint on Canvas Create a masterpiece painting on canvas
Learn basic chords & play a song by the end of the week
_____ Pinewood Derby th th (4 -6 grade)
_____ Sewing for beginners (Ages 8+)
Design, sand, paint, build, and race a pinewood derby car
Sew a purse, pillow, stuffed animal, tote bag, zipper pouch, apron or pencil case
_____ Puppetry Learn the art of puppetry, create a puppet, and perform
_____ Soccer
_____ Quilting (Ages 8+)
_____ Stained Glass Art
Learn how to make a small wall quilt from start to finish
Create a painted stained glass
Have fun playing soccer
_____ Outdoor Games Tag games, Dodgeball, Prisoner, water fun, and more
_____ Baseball
_____ Volleyball
Have fun playing baseball and build your skill
Have fun playing volleyball and build your skills
Kids in Action Explore Activities Your child will participate in up to nine Explore activities during Kids in Action Day Camp. Some activities will take more than one session. Please notice the number next to the title, this denotes how many sessions it will take to complete. Please rank 1st – 15th choice for activities. We will do our best to accommodate all students, however, some activities are limited and may take more than one session to complete. _____ Archery
_____ Capture the Flag
_____ Garden Flower Art
_____ Pinewood Derby (2)
Learn skills of how to shoot a bow and arrow (age 8+)
Strategy and fun
Make a beautiful painted glass flower to put in a garden
Assemble, paint and race a car
_____ Ceramics (3)
_____ Backyard Games
Create and paint a lidded pot
Have fun playing horseshoes, corn hole, ladder ball and more
_____ Cooking
_____ Glue Watercolor Painting (2) Use glue on canvas to make a beautiful watercolor painting
Cook and eat with master chef Kip
_____ Baseball Have some fun in the sun
_____ Cupcake Decorating Learn how to frost, decorate, and eat cupcakes like a chef
_____ Basketball
_____ Bottle Rockets Build and launch bottle rockets
Learn some fun varieties of this classic game
_____ Miniature Gardening
_____ Sound Recording
_____ Mini Golf
_____ Volleyball
Have fun playing 9 holes of miniature golf
Have fun in the sand
_____ Nerf Battle
_____ Exploring Dance
Make your own Bouncy Ball
Get your move on
Bring your own, or borrow some of ours
_____ Cake Decorating (2)
_____ Fidget Spinners
Learn different piping strokes, decorate your own cake
Make your very own fidget spinner
_____ Outdoor Games
Get ready to rumble
_____ Soccer
Make your own mini garden to take home
_____ Bouncy Balls
_____ Flag Football
Make your own Silly Putty
Fun in the sun
Have some fun playing ball
_____ Dodgeball
_____ Silly Putty
Tag games, Dodgeball, Prisoner, water fun and more
Make and record your own music
_____ Water Games Slip-n-Slide, water balloons, and more – swimsuit recommended
_____ Wind Chimes Build a wooden wind chime
_____ Wood Picture Holder Create a beautiful wood picture holder
Please drop off or mail registration form, along with payment to: Redeemer Covenant Church. 6800 Main Avenue, Orangevale, CA 95662
Child’s First Name _____________________________________________________________ Child’s Last Name _________________________________________________________
REDEEMER COVENANT CHURCH 2017 PERMISSION SLIP, LIABILITY RELEASE, MEDICAL RELEASE, MEDIA RELEASE, AND MEDIATION AND ARBITRATION AGREEMENT PLEASE READ CAREFULLY BEFORE SIGNING I expressly consent to the participant’s involvement in all activities and events during the calendar year 2017 including, but not limited to, recreational activities, trips, travel, and activities related to missions. The participant agrees to comply with all rules and policies for each activity and event. I understand that participation in each activity and event involves inherent and other risks of INJURY and DEATH. In consideration for the participant’s being permitted to be involved in activities and events during the calendar year 2017, I AGREE TO RELEASE Redeemer Covenant Church and its pastors, officers, staff, employees, volunteer workers, attorneys, agents, representatives, affiliates, successors-in-interest, and assigns (collectively “PROVIDERS”) from any and all personal liability, in excess of the applicable limits of any insurance providing coverage to PROVIDERS for injury, death, and property loss and damage that arises out of or results from the activity or event, including all liability which results from the negligence of PROVIDERS, or any other person or cause. I authorize any person connected with Redeemer Covenant Church or the activity or event to administer first aid to the participant, as they deem necessary. I authorize medical and surgical care and transportation to a medical facility or hospital for treatment necessary for the participant’s well-being, at my expense. By entering my child in this program, I hereby release any photos and/or video footage of my son/daughter that may be taken during any Redeemer Covenant Church event. I understand that my child’s name will not be published in conjunction with any publication. Pictures taken at Redeemer Covenant Church will not be sold for any reason to an outside organization, and I hereby waive any right to compensation for said photographs, videos, etc. This agreement is binding upon the participant’s heirs, executors, administrators, and assigns. I acknowledge this agreement is governed by the applicable laws of the State of California. If any provision of this agreement is held in whole or in part to be unenforceable for any reason, the remainder of that provision and of the entire agreement will be severable and remain in effect.
I HAVE READ, UNDERSTAND, AND VOLUNTARILY AGREE TO THIS LIABILITY RELEASE, MEDICAL RELEASE, MEDIA RELEASE, AND MEDIATION AND ARBRITRATION AGREEMENT. Parent/Guardian: If participant is a minor, I verify that I am the parent or guardian of the minor, and I have authority to enter into this agreement on behalf of the participant.
Parent/Guardian’s Signature: ______________________________Date:______________