Register - Cypress Creek Church

Number of Kids Registering:*

Please enter a number from 1 to 4.

Child #1

Name (Child #1)*

First Last

Age (Child #1)*

(must be 4yo by the first day of camp)

Grade (Child #1)*

(entering into the fall)

Food Allergies? (Child #1)*

Yes

No

Food Allergies (Child #1):*

Would you like to preorder a t-shirt ($12)?*

Yes

No

T-Shirt Size (Child #1)*

2025 Kids Camp T-Shirt

Child #2

Name (Child #2)*

First Last

Age (Child #2)*

(must be 4yo by the first day of camp)

Grade (Child #2)*

(entering into the fall)

Food Allergies? (Child #2)*

Yes

No

Food Allergies (Child #2):*

Would you like to preorder a t-shirt ($12)?*

Yes

No

T-Shirt Size (Child #2)*

Child #3

Name (Child #3)*

First Last

Age (Child #3)*

(must be 4yo by the first day of camp)

Grade (Child #3)*

(entering into the fall)

Food Allergies? (Child #3)*

Yes

No

Food Allergies (Child #3):*

Would you like to preorder a t-shirt ($12)?*

Yes

No

T-Shirt Size (Child #3)*

Child #4

Name (Child #4)*

First Last

Age (Child #4)*

(must be 4yo by the first day of camp)

Grade (Child #4)*

(entering into the fall)

Food Allergies? (Child #4)*

Yes

No

Food Allergies (Child #4)*

Would you like to preorder a t-shirt ($12)?*

Yes

No

T-Shirt Size (Child #4)*

Contact Information

Parent's Name*

First Last

Phone*

Email*

Email Signup

Subscribe me to the monthly Cypress Creek Kids Newsletter

Subscribe me to the Cypress Weekly

I'd like to learn more about serving during Kids Camp by:

Teacher/Assistant Teacher

Registration

Breakfast

Do we have permission to take photos of your child(ren)?*

Yes

No

Payment

Total

Credit Card*

Card Details

Cardholder Name

Address

Street Address City State ZIP Code

Parent Release

Emergency Contact Name:*

Emergency Contact Phone Number:*

Insurance Company:

Insurance Policy #:

I, the undersigned, hereby release Cypress Creek Church, it's agents, employees, officers and servants, from any and all damages and injuries which may occur while (I/ my child) is participating in any/all Cypress Creek Church activities, on or off the premises. I also give my permission for Cypress Creek Church leadership to seek medical attention by a licensed physician in the event of a medical emergency. I certify that I have the legal authority to execute this release on behalf of (myself/ my child). I also agree, by signing below, that the above information is true and correct to the best of my knowledge.

Participant or Parent/Guardian Signature (if under 18 yrs. old)*

Date*

Phone

This field is for validation purposes and should be left unchanged.