Camper (Preferred) First Name *

Camper Last Name *

Gender * Select ...MaleFemale

Age of camper on August 1, 2023 * Select ...678910111213

Current Grade * Select ...123456

Email (All camp communication and information will be sent to this email.) *

Mother's First Name (If not applicable, type none.) *

Mother's Last Name (If not applicable, type none.) *

Mother's Cell Phone Number (If not applicable, type none.) *

Mother's Email (If not applicable, type none.) *

Father's First Name (If not applicable, type none.) *

Father's Last Name (If not applicable, type none.) *

Father's Cell Phone Number (If not applicable, type none.) *

Father's Email (If not applicable, type none.) *

Street Address *

City *

State *

Zip Code *

Home Phone Number (Include area code.) *

Home Church

School Camper Attends *

I have attended KOV in the summer * Select ...YesNo

T-Shirt Size * Select ...Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LAdult XL

Name of Emergency Contact (Father and mother will be contacted first - please list someone who is not the father or mother.) *

Relationship with camper of emergency contact *

Day time phone number of emergency contact *

Cell phone number of emergency contact *

Primary Contact * Select ...FatherMotherEmergency Contact

Camper Allergies (If not applicable, type none.) *

Camper Medications (If not applicable, type none.) *

Special Needs Considerations (If not applicable, type none.) *

My child has permission to participate in all KOV Christmas-2023 events. All activities will take place at 9820 East Watson Road, Crestwood, MO 63126. I give my consent for my child to be photographed as a part of KOV programming and nonprofit promotions. In the event that my child needs medical attention during KOV Christmas-2023, including over the counter medications, I give permission for Ministry Staff to administer medical treatment or admit to a hospital for emergency treatment. I further agree to hold harmless and re-lease from liability Southgate Church, its ministers, and anyone acting on behalf of KOV Christmas-2023 for any and all injuries sustained while at KOV Christmas. * I Agree

No friend requests for KOV Christmas. If your child has medical obligations which requires them to be with a specific buddy, please make this request known to us via email through the website contact us form. By checking the box, you agree to have read the above statement concerning friend requests this year and will respect and honor this new rule. * I Agree

Medical Release (I give my permission to administer over the counter medication.) * Select ...YesNo