2026 Summer Camp Registration Form

Program Name: Chosen Remnant Summer

Camp Duration: 4 Weeks (June 29th – July 23rd, 2026)

Schedule: Monday – Thursday

8:00 AM – 2:00 PM

Target Group: Rising 2nd – 5th Grade Students Capacity

Maximum 12 Students

Best Contact #: Crystal McLean -910.303.6950

Youth Full Name *

First and Last Name

List any Allergies/Medical Conditions (If None, place N/A) *

Allergies/Medical Condition

Parent/Guardian First Name *

Parent/Guardian Last Name *

Phone *

Email *

Emergency Contact First and Last Name *

Emergency Contact Phone Number *

By checking this box, I consent and give permission for my child/children to attend the Chosen Remnant Ministries Summer Camp.

I authorize the supervising camp staff and volunteers to administer basic first aid if needed, and in the event of an emergency, to seek appropriate medical care.
I give permission for my child to be photographed or recorded during the camp for camp-related purposes, such as newsletters, social media, and internal presentations.
I understand that reasonable measures will be taken to ensure my child’s safety, and I will not hold Chosen Remnant Ministries, its staff, or volunteers liable for any accidents or injuries that may occur during the camp.

Acknowledgment of Payment: By checking this box, I acknowledge that the weekly rate for the Chosen Remnant Ministries Summer Camp is $80 per week, due every Monday for the start of the full week. I understand the payment schedule and confirm that I am willing and able to pay the required amount for my child/children’s participation in the camp. If paying via Cash App, please send to $CRMFay2727 and in the for section put (CRM SUMMER CAMP - STUDENT'S NAME) *

Yes

Do you anticipate needing assistance with transportation to and from the Chosen Remnant Ministries Summer Camp, if available? If yes, please briefly explain why: *

Yes

If yes to transportation please explain below:

Parent/Guardian Signature *

Clear