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Cullen@LivingAbundantlyTX.com
Home
About Us
Mission Statement
Statement of Faith
History
About Our Executive Director
Photos
Programs
116 Ambassadors
All Star Sports Camp
HIMpact
Calendar
Sermons
Connect with Us
Contact Us
Online Giving
Online Newsletter
All-Star Sports Camp Registration Form
Home
All-Star Sports Camp Registration Form
Fieldset
Child's Last Name
*
Child's First Name
*
Child's Middle Name
What activity will child participate in during camp
*
Baseball
Basketball
Cheerleading
Football
Soccer
Arts & Crafts
Praise Dance
Parent/Guardian Name(s)
*
Address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Phone Number
*
Alternate Number
Email
School child will attend in the new school year
*
IF CHILD'S GRADE IS NOT ONE OF THE OPTIONS BELOW, THEY ARE NOT ELIGIBLE TO ATTEND THE ALL-STAR SPORTS CAMP
Grade child will be in when school starts
K
1
2
3
4
5
6
Church Child Attends
Race
Birth Date (month/day/year)
*
Gender
*
Female
Male
Child's Physician
Physician's Phone Number
Hospital of Choice
Emergency Contact Information
In case of injury or other problems (OTHER THAN PARENT/GUARDIAN
Name
*
Relationship
*
Phone
*
Name
Relationship
Phone
Transportation
My Child will get to and from camp by: (select one)
*
Walking to and from
By family car
Children's World
Asbury Kids
LYLA
Lakeridge Baptist
Pick Up
My child has permission to ride home with the following people (Besides parent/guardian(s) already listed
Name
*
Phone
*
Name
Phone
Name
Phone
Medical History
Please list any conditions that might limit your child's activities at camp.
*
If there is none, please put NA
Does your child have any allergies (including medicines and foods)? If so, please specify
*
If your child does not have any allergies, please put NA
Is your child currently taking any medications? If so, please list each medicine with dosage information.
*
If your child does not take any medication, please put NA
Does your child have any medications they need during camp? If so, please list each medicine with dosage information
*
If your child does not carry any medicine with him/her, please put NA
How did you hear about the All_Star Sports Camp
*
How did you hear about the All-Star Sports Camp
Facebook
Camp postcard
I saw a flyer in the community
I heard an ad on radio
I saw information at my child's school
Camp information was left at my house
From a program my child attends
I got information at a local library
I got information at a local grocery store
I got information at the Lubbock Dream Center
I got information at my church
Oher
Instructions
I, the parent or legal guardian, of the child named above, hereby grant my permission for him/her to participate in the All-Star Sports Camp. I acknowledge the fact that he/she is physically able to participate in camp activities. I release the All-Star Sports Camp, its employees, Board of Directors, Volunteers, and/or sponsors from all claims from injuries or illnesses which may be sustained by my child due to any participation, transportation in effect of any other of the activities thereof, and authorize treatment of the above named camper on an emergency basis in the event that such treatment becomes necessary while attending camp. I also give my permission for any picture taken during camp of my child to be used in presentations and publicity. I understand that any identifying information such as my child’s name will not be used in the pictures. It is understood that All-Star Sports Camp may be required to perform basic first aid if a child is injured while participating in the camp. I UNDERSTAND THAT SINCE THIS IS A SPORTS CAMP, MY CHILD IS REQUIRED TO WEAR CLOSED-TOE SHOES, AND THAT SANDALS OR FLIP FLOPS ARE NOT PERMITTED TO BE WORN AT CAMP. I HAVE READ AND UNDERSTOOD THE PARENTS' GUIDEBOOK FOR THE ALL-STAR SPORTS CAMP.
Electronic Signature (please type name here)
*
Date
*
Verification
Please enter any two digits
*
Example: 12
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