Summer Registration 2020

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2020 Summer Registration

CIA offers free recreational ministry to children (boys & girls) between the ages of 7 and 12.
All activities are Christ-centered focusing on Character, Excellence and Teamwork.
Camps are 8:30-12:30, Monday-Thursday
2019 camps will be located at Selden Park.
Free Breakfast will be served at 8:30 am, and Free Lunch at noon.

Camps dates are:

Sports offered are:
Basketball
Ultimate Frisbee
Football/Volleyball
Wiffle Ball (Baseball & Softball)

Additional activities include:
Pickleball
Dodgeball
Obstacle Course
Field Day Activities
Character building/Huddle/Devotion

* Indicates required field

Parent/Guardian's Name: *

First

Last

Parent/Guardian's Email: *

Cell Phone: *

Alt. Phone: *

Address *

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Line 2

City

State

Zip Code

Country

Emergency Contact: *

First

Last

Emergency Contact:

Email *

Cell Number: *

Alt. Phone: *

Address *

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State

Zip Code

Country

1st Camper's Name: *

First

Last

[object Object]

Gender: *

Male Female

Age: *

5 6 7 8 9 10 11 12

2nd Camper's Name: *

First

Last

Gender: *

Male Female

Age: *

5 6 7 8 9 10 11 12

3rd Camper's Name: *

First

Last

Gender: *

Male Female

Age: *

5 6 7 8 9 10 11 12

4th Camper's Name: *

First

Last

Gender: *

Male Female

Age: *

5 6 7 8 9 10 11 12

5th Camper's Name: *

First

Last

Gender: *

Male Female

Age: *

5 6 7 8 9 10 11 12

HOW DID YOU HEAR ABOUT CIA'S SUMMER CAMPS *

Asthma (Choose One) *

My child(ren) "DO NOT" have Asthma. My child(ren) "DOES HAVE" Asthma. I will print the "ASTHMA ACTION PLAN FORMS" and present pages one and two the first day of camp. I understand, for my child(ren)'s safety, my child(ren) will not be able to participate without "THE ASTHMA ACTION PLAN".

Please identify which camper(s) have Asthma. If none, please type N/A. *

click here for Asthma Action plan forms

Concussion Documents *

I have read CIA's concussion documents to stay abreast of symptoms related to concussions concerning my child's health

Click here for concussion documents

Pictures/Videos *

Throughout the year, there are occasions when CIA Sports Club will take pictures/videos of your child(ren) participating in activities. We may use, duplicate, broadcast, distribute, and display these pictures/videos in CIA publications, local newspapers, advertising or on websites maintained for CIA. Thank you in advance for your permission, support and understanding.

Release Form *

I HAVE READ AND FULLY UNDERSTAND THIS FORM. I, as parent or Guardian, hereby give my consent for my child(ren) to participate in activities and in consideration of CIA Sports Club allowing my child(ren) to participate in any related activities, and for other good and valuable consideration, I hereby covenant and agree not to sue CIA Sports Club, or any staff, member, or coach thereof, and hereby release and forever discharge CIA Sports Club, or any staff, member, or coach thereof from any and all claims, demands, rights and causes of action of whatsoever kind of nature for any damages including bodily or personal injury sustained by my child and arising from his or her participation in such activity, sponsored by CIA Sports Club, including transportation in such activity. I authorize any staff, member or coach of CIA Sports Club associated with the program to obtain, through a physician of its own choice, any emergency medical care that may seem to them to be necessary for my child(ren). I agree to pay all associated costs.

Submit

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