Reserve Your Child's Spot

$140 / week · July 6 – 10, 2026 · Mon – Fri · 9:00 AM – 4:00 PM

DOJ Ministry × Reign Bots Innovation Lab

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Child Intake

Tell us about your camper.

Child's Full Name

Age

Grade (Fall)

Parent / Guardian

Parent Name

Phone Number

Home Address

Emergency Contacts & Procedures

In the event of an emergency, staff will follow Kingdom Kids VBE emergency protocols: trained adult response, immediate parent notification, and 911 contact when warranted. Children are evacuated to the church fellowship hall in the event of a building emergency.

Primary Emergency Contact (name & phone)

Alternate Emergency Contact

Child's Physician

Physician Phone

Insurance Provider / Policy #

I acknowledge that I have read and understand the camp's emergency procedures, and I authorize staff to seek emergency medical treatment for my child if I cannot be reached.

Allergy & Medical Documentation

All snacks are nut-aware. Please document every allergy, medication, and condition; staff cannot administer undocumented medication.

Known Allergies (food, environmental, insect, latex, medication)

Allergy Severity

My child carries an EpiPen / emergency inhaler (sent with child each day).

Daily Medications & Dosage

Medical Conditions / Alerts (asthma, diabetes, seizures, etc.)

Dietary Restrictions

Special Needs / Accommodations

Behavioral / Sensory Needs

I certify the allergy and medical information above is accurate and complete to the best of my knowledge.

Pickup Authorization

Only adults named below (with photo ID) will be permitted to sign your child out. Pickup ends promptly at 4:00 PM.

Authorized Pickup (full names & relationship)

Persons NOT permitted to pick up my child (optional)

Consents, Waivers & Photo Release

Snack & Meal Permission — I grant permission for my child to receive snacks and meals provided by camp staff.

Photo & Media Release — I consent to my child being photographed or filmed for camp highlights, ministry promotion, and social media. (Uncheck to opt out.)

Liability Waiver & Release

I, the undersigned parent or legal guardian, give permission for my child to participate in all Kingdom Kids VBE Summer Camp activities, including indoor STEAM experiments, movement games, and creative arts. I understand that, while staff exercise reasonable care, participation involves inherent risks. I release DOJ Ministry, Reign Bots Innovation Lab, the host church, and their volunteers, employees, and affiliates from any liability, claim, or expense arising from my child's participation, except in cases of gross negligence. I confirm my child is in good health and physically able to participate.

I have read, understood, and agree to the Liability Waiver & Release above.

Parent / Guardian Signature

All staff and volunteers complete background checks prior to camp. Typing your name below acts as your legal electronic signature for all forms in this packet.

Type Full Legal Name

Date

Interested in volunteering or joining staff?

All volunteers and staff complete a background check, child protection training, and reference review before camp begins. Email volunteers@dojministry.org to receive the volunteer application packet.