2025 Kidz Days Registration

Completion of this form will sign your child up for the KidzDays Daycamp on June 16-19 (Mon. - Thurs. 9am-2pm & Friday No Camp). The medical release information is required if your child will be a part of the camp. This camp is for those children that have completed K-5th grade this year.

Child Information

If you have more than 1 child participanting, you will need to fill the form out for each child.

Child's Name

Grade Just Completed as of June

T-Shirt Size

XS S M L XL

Parent Information

Parent Name

Parent Email

This address will receive a confirmation email

CONSENT TO TREAT MINOR CHILDREN

I am the parent or legal guardian do hereby consent to any medical care and the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child is under the care of Blue Springs Baptist Church of Grainger County, Rutledge, Tennessee and I am not reasonably available by telephone to give consent. This authorization is effective from the 17th day of June, 2024 to the 21st day of June, 2024.

*Electronic Signature

Electronic Signature Date

*By entering my name in the box above, I am providing my digital signature on this Form.

Family Address

Father/Guardian 1 Phone

Mother/Guardian 2 Phone

Allergies to drugs or foods:

Special Medications, Blood Type or Pertinent Information:

Child's Physician Name

Child's Physician Phone

Insurance:

Insurance Policy #

By checking this box, I am indicating that the above information is accurate.

This information should be taken with the child to the hospital or physician's office when the child is taken for treatment. This additional information will assist in treatment.

Description

Please fill out this form and click submit.
The following link takes you to our Privacy Policy and explains how your information will be collected and safeguarded. https://www.bluespringsbaptistchurch.org/privacypolicy

2025 Kidz Days Registration

Description

Please Fix the Following