Camper's Name *

First Name

Last Name

Parent/Legal Guardian's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Work Phone

(###)

###

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Camper's Date of Birth *

MM

DD

YYYY

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Do you give the Colorado Springs Christian Church Children's Ministry permission to photograph and/or film your camper(s) to use publicly in VBS materials? *

The images may be used for VBS related presentations and our website. Additionally, no royalty, fee, or other compensation shall become payable to you by reason of such use.

Yes, I give the CSCC permission to photograph/film my camper(s) to use publicly.

No, I do not give the CSCC permission to photograph/film my camper(s).