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Camper's Name:
Camper's Age:
Boy or Girl?:
1st Parent/Guardian's Name:
2nd Parent/Guardian's Name:
Best Contact Phone:
Email Address:
Total Amount You Payed via Paypal?:
Email address used with your Paypal payment?:
Mailing Address:
Medical Conditions * If none write "none" in box:
Allergies *If none write "none" in box:
Camper's Doctor:
Doctorʻs Phone Number *List individually if more than one:
By Checking this box I am acknowledging that I have read and understand the following: Emergency Release: In case of accident or other emergency, I authorize the Camp Good News staff to obtain any needed medical or surgical care for my child from our Physician or another medical professional. I understand that the Camp will attempt to contact me if this occurs. While all Camp activities are supervised by adults, I understand that my child is participating at their own risk. In the event of accident or injury while at Camp, I will assume responsibility for all expenses. In addition, I agree to take full responsibility and hold harmless all individuals and entities connected with Kauai Christian Academy, Makanalani Kids House, etal.
Parent's Signature: *Typing your name in this box will be considered your electronic signature and will be considered the same as your written signature:
Date: