2026 Wiggly Worship Summer Camp Registration

Wednesdays June 3, 10, 17, 24 from 10:00-11:15 | Parents/Guardians, please fill out this form and click submit. After submitting this form, you can restart it to register another student.

Please email Julie (jumpjulie22@gmail.com) with any questions.
CHILD INFORMATION
 
 
 
Please select one option.
 
Please select one option.
Please select all that apply.
CHILD HEALTH INFORMATION
Allergies: (Medication, Food, Insect, Etc) [Ex: Penicillin, Seafood]
 
 
 
 
Conditions / Special Needs: (Other Medical or Behavioral Conditions)? [Ex: Asthma, ADHD, Autistim, etc.]
 
 
 
 
Additional Notes: Is there anything additional that we should know about your child?
 
 
 
 
PARENT/GUARDIAN INFORMATION
 
 
 
 
 
 
 
EMERGENCY CONTACT INFORMATION
Please provide an emergency contact for your child if we cannot reach you or a second parent/guardian as stated above.
 
 
 
ACKNOWLEDGEMENTS
Photo / Video Consent: I authorize the use of video and/or images of the above child/minor for social media posts and/or other visual material of First Church.
Please select one option.
Permission Acknowledgement: I give permission for the above child/minor to attend and to be transported to and from First Church gatherings and events.
Please select one option.
Release Acknowledgement: It is our great pleasure to serve our community and to have your child/minor participate in our gatherings and events! We do make effort to provide safe and appropriate environments, as well as safe and responsible drivers to provide transportation. That said, we all understand that accidents do happen and unforeseen incidents do occur. Thus, it is our reminder to you that your signature will completely and unconditionally indemnify, hold harmless, and release First Church and its agents, employees, volunteers, and persons from any and all liability cause by negligence of First Church and said persons or behaviors of child/minor for personal injuries, property damage, or wrongful death, in the participation and/or transportation to and/or from First Church and its related events.
Please select all that apply.
Electronic Signature: I consent to the signing of this release form by an electronic signature.
Please select all that apply.
 

Description

Wednesdays June 3, 10, 17, 24 from 10:00-11:15
Parents/Guardians, please fill out this form and click submit. After submitting this form, you can restart it to register another student.

Please email Julie (jumpjulie22@gmail.com) with any questions.