Break Away Day Camp

Name: Break Away Day Camp
Start: 2021-07-26
End: 2021-07-29
Location: I-70 Campus

Break Away Day Camp is a four-day experience for kids who are entering 1st through 5th grade. Break Away 2021 will take place July 26-29. Kids will experience fun through indoor and outdoor activities, water games, crafts, Bible teaching and worship – all designed to help kids know Christ and make Christ known.

To register for Break Away:
1. Complete the online registration form (below) for each camper.

2. Download, complete and notarize the parental permission form. This form should be submitted to the church office prior to Break Away, or presented at check-in on the first day of camp. You may have your form notarized at the church office during normal business hours (M-TH: 8:30-5:00, FRI: 8:30-Noon).

3. Submit payment of $60 per camper. Payment must be made here on our website (below) at the time of registration via credit/debit card/ach withdrawal.

If you are interested in scholarship or fundraising information for your child, please contact the church office.

Willing to help with Break Away? Click here to volunteer.

REGISTRATION

CAMPER INFORMATION
Camper's Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Gender*
- Male
- Female
Grade Level Your Child Is Entering*
Address*
Street Address Address Line 2 City State ZIP Code
PARENT / GUARDIAN INFORMATION
Parent / Guardian's Name*
First Last
Email
Phone
Parent / Guardian #2
First Last
Email
Phone
Additional Emergency Contact Person*
First Last
Please provide someone we can contact if the parent / guardian cannot be reached.
Emergency Contact's Relationship to Camper
Emergency Contact Home Phone
Emergency Contact Mobile Phone*
ABOUT YOUR CAMPER
T-Shirt Size*
T-shirts will be guaranteed for those that register by July 11
Generally, the camper's health is (check one):*
- Excellent
- Good
- Fair
- Poor
List any medical difficulties which are currently being treated:
List any operations or serious illnesses the camper has previously had:
List any medications currently being taken (include dosage and time):
List any allergies:
Groups at Break Away are based off grade level. List 1-2 friends your child would like to be grouped with if possible.
Additional info that would help your child be successful at Break Away:
The cost for Break Away is $60 per camper. Payment can be made using the online form below.
Electronic Signature*

Please type your first and last name
*
- I understand this constitutes a legal signature confirming that I acknowledge and agree that the above information is true and accurate.

PAYMENT

days

hours

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Date

Jul 26 - 29 2021

Time

9:00 am - 4:00 pm

Location

I-70 Campus

Break Away Day Camp

REGISTRATION

CAMPER INFORMATION

PARENT / GUARDIAN INFORMATION

ABOUT YOUR CAMPER

PAYMENT

Date

Time

Location