2024 MEGA Fun Days Registration

Please fill out this form and click submit.

Date: February 17th - 18th
Location:

Centerville Community Church
401 Wilson Drive

Centerville, Georgia 31028

Time:

Drop Off: 8:30 am - 9:00 am
Pick Up: 3:30 pm - 5:30 pm

Guardian's Name

Guardian's Email

This address will receive a confirmation email

Guardian's Phone

Guardian's Address

Camper's Name

Camper's Age

Camper's DOB

Camper's Address

Camper's Gender

Please select one option.

Male Female

Emergency Contact

Relationship to Camper

Emergency Contact's Phone

Special Concerns (Allergies, Medications, Medical Conditions, etc.)

Please check what medications this camper may receive:

Please select all that apply.

Advil Ibuprofen Claritin Aspirin Tylenol Benadryl Mylanta Pepto-Bismol Nasal Decongestion Cough Syrup Tums Pepcid

I (parent/guardian) do herby state that I have legal custody of the child, a minor who resides with me. While this minor is a registered camper at Centerville Community Church, I hereby authorize any director, nurse, or any other responsible personnel of said camp to deliver First Aid or medicine, I have provided information about in step one.

Please select all that apply.

Initial

I, also, understand by allowing my child to participate in “Mega Fun Days” there is risk of injury. I hereby release, discharge, and hold harmless Centerville Community Church, its employees, volunteers and other representatives from any claims arising out of or relating to any physical injury that may result to the registering player while participating in the Mega Fun Days event.

Please select all that apply.

Initial

I consent to the taking of photographs and/or video of the minor and release Centerville Community Church to use said photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media.

Please select all that apply.

Initial

Payment (Includes Breakfast and Lunch)

Monday & Tuesday ($20.00) Monday Only ($15) Tuesday Only ($15)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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2024 MEGA Fun Days Registration

Description

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