Staff Position
Personal/Contact Information
Name *
Birthdate *
Address *
Main Phone *
Main Phone
Cell Phone
Cell Phone
Texting Okay? *
Emergency Contact
Emergency Contact
Emergency Contact Number *
Emergency Contact Number
Saved *
Have you been filled by the Holy Spirit *
Medical Information
Medical Insurance *
Do you have and medical conditions or allergies we need to know about? *
Permission and Liability Release
Parental Permission: I, the parent or legal guardian of this participant, hereby grant my permission for him/her to participate fully in "Children's Camp 2019", and hereby give my permission to take said participant to a doctor or hospital and hereby authorize medical treatment, and agree to assume the responsibility of all medical bills, if any. Liability Release: For Children's Camp 2019, I do, on behalf of myself or my child under the age of 18 hereby release, and forever discharge and agree to hold harmless Zion Spokane and the directors thereof from any and all liability, claims, demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred during by my child while said person is while participating in Children's Camp 2019 furthermore, I, on behalf of my child, hereby assume all risk of personal injury, sickness or death as well as property damages and expenses as a result of participation and activities involved therein. Further, authorization and permission is hereby given to said church to furnish transportation, food, and lodging for this participant. By checking this box below and clicking the Submit button you are confirming that you have read and agree to the Permissions and Liability Release statement printed above and wish to register for the event. If you have questions regarding the Permission and Liability Release statement printed above please the church office at 509-489-8073 before clicking Submit button.


$100 due


Tuesday, June 25 at 6:30 at Zion Spokane

545 E. Wellesley Ave Spokane, WA 99207