Child #1 (List Oldest to Youngest) *

First Name

Last Name

Child #1 Date of Birth *

MM

DD

YYYY

Child #2

First Name

Last Name

Child #2 Date of Birth

MM

DD

YYYY

Child #3

First Name

Last Name

Child #3 Date of Birth

MM

DD

YYYY

Parent Guardian #1 Name *

First Name

Last Name

Parent/Guardian #2 Name

First Name

Last Name

Primary Phone Number *

(###)

###

####

Secondary Phone Number

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Release and Liability Waiver *

Please read carefully and contact Clint McClure at the church at 661-267-2200 or clint@faithtoyou.com if you have any questions or concerns.

By registering and checking this box, I give my permission for Faith Community Church to secure medical services for my child(ren) should it be necessary and will not hold Faith Community Church, its directors, its staff, or its volunteers liable for damages. I also understand that photo and/or video images will be taken during Camp Faith, that images will not be sold, and that my child(ren)’s identity will remain anonymous. Therefore I give permission to Faith Community Church to use photo/video images for promotional purposes. I also acknowledge that I must sign this waiver in person upon arrival to check in my child(ren) on July 10, 2023.