Youth Supernova Summer Spirit Camp Registration Form

Child's Name

Guardian's Name

Address

Phone Number

Email Address

Birthdate

Age

Grade

Please list any additional children that will be attending. Include their name, age, date of birth and grade

In case of emergency contact (other than guardian who will be first contact)

Emergency Contact Phone Number

Relationship to Child

Allergies/Medical Conditions we should be aware of

Photography Release: I hereby grant the Church and their representatives permission to use photographs and videotaped images in which my child appears, in any manner whatsoever such as, but not limited to: publication, display, advertising, slide show, etc Please type yes or no

Please Sign and Date - My child has my permission to attend and participate in the Supernova Spirit Camp program.