Super Hero Summer

Super Hero Summer Registration Form for K to 6th grades

May 30 to June 2, 2017, 6:00 to 8:00 pm

(Registration deadline is May 28)

Family Name:
Child 1's Name:
Child 1's Birthday:
Child 1's Grade in 2017-18:
Child 1 T-Shirt size:

Child 2's Name:
Child 2's Birthday:
Child 2's Grade in 2017-18:
Child 2 T-Shirt size:

Child 3's Name:
Child 3's Birthday:
Child 3's Grade in 2017-18:
Child 3 T-Shirt size:
Phone Contact(s): Cell and/or Home
Alternate Contact Name:
Alternate Contact Number:

SPECIAL NOTE: If someone will not be available at one of these numbers on any evening during the week of Super Hero Summer, please let us know where to contact you by sending a note with your child or give it to their Group Leader. We want to be able to contact you if there is an emergency.

Will or may someone other than the listed parent or parents be transporting your child to and/or from Super Hero Summer?

The person bringing my child or children is:
The person picking up my child or children is:

Special Needs, Medications, Allergies, etc, that we should be aware of. Please list by child.

Child 1 Special Considerations:
Child 2 Special Considerations:
Child 3 Special Considerations:

FIRST AID and EMERGENCY Procedures: By submitting this form I consent for my children to follow the directions of the Super Hero Summer leaders and to obey the camp rules. I give permission for the Super Hero Summer leaders to take necessary first aid action should any medical emergencies occur. Any unacceptable behavior or emergency, other than minor scrapes or cuts, will be reported to a parent as soon as possible after the incident.

PHOTO/VIDEO Release: I hereby grant and authorize Chandler Bible Church the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of my child(ren) in connection with "Super Hero Summer 2017" to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, submissions to journalists, websites, social networking sites and other print and digital communications, without payment or other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing.

I understand and agree that these materials shall become the property of Chandler Bible Church and will not be returned.
I hereby hold harmless, and release Chandler Bible Church from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other person make while acting on my behalf or on behalf of my estate.

I understand that my submission of this Registration Form constitutes my agreed upon consent to this Photo/Video release.


Make an online donation to Super Hero Summer