Camp Registration Form – Grace Communion Surrey Hills

Camp Registration Form

Camper First Name *

Camper Last Name *

Does the camper go by a different name? If yes, please let us know.

Camper Date of Birth *

What grade group will your camper be starting fall 2026?

K - 3rd
4th - 7th

What is the grade the camper will be going into in the fall 2026?

Gender

Is your child potty-trained? *

Yes
No

Has your child been to Camp Surrey before? *

Yes
No

Does the camper have any known special health conditions and/or allergies? *

Yes
No

Please list ALL special health conditions and/or allergies. AND PLEASE DESCRIBE IN DETAIL THE SEVERITY OF THE ALLERGY. For example, “my child cannot have anything manufactured in a facility with peanuts.” “My child cannot be in the same room as tree nut products.” *

Does the camper require any special needs/assistance? *

Yes
No

What kind of assistance does the camper need? *

Shirt Size *

Comments or Questions

Contact Information

Camper Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent or Legal Guardian Contact Information

Name of Parent or Legal Guardian *

First

Last

Relationship to camper *

Parent
Legal Guardian
Other

Please explain *

Email *

Phone *

Work Phone

Can you receive text messages? *

Yes
No

Is the parent or legal guardian's address the same as the camper?

Yes
No

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Information

Please enter the name of the parent or guardian who should be contacted in the case of an emergency.

Emergency Contact Name #1 *

First

Last

Relationship to camper *

Parent
Legal Guardian
Other

Emergency Contact #1

Please explain *

Emergency Contact #1 Phone *

Emergency Contact Name #2 *

First

Last

Relationship to camper *

Parent
Legal Guardian
Other

Emergency Contact #2

Please explain *

Emergency Contact #2 Phone *

Questions or Comments

Required Acknowledgement of Agreements

PLEASE NOTE: To read all agreements before initialing, go to gcsurreyhills.org/campsurrey/camper-agreements or head back to the Camp Surrey Home Page and scroll to the bottom and click the Camper Agreement Link.

Kayaking: All participants will be provided with and must wear life vests and whistles at all times. (Mini Campers will only be permitted to tandem kayak with a staff member) Your camper has permission to...

My camper may Kayak in their own Kayak under adult supervision.
My camper may Kayak tandem with an adult staff member.
I prefer my Camper NOT participate in Kayaking.

Pool: Your camper has permission to...

My camper is not a swimmer (wading pool only)
My is a beginner swimmer, shallow end only.
My camper can swim the entire pool with floaties.
My camper is a good swimmer (entire pool)

If your camper needs floaties, parents need to provide floaties, labeled with name, for pool day only.

Climbing Wall permission (for campers 10 years of age and older)...

I have read all of the statements and all of the policies of the Climbing Wall and give permission for my child to participate in the auto-belay climbing wall challenges at Camp Surrey under direct adult supervision.
My child does NOT have permission to participate in the auto-belay climbing wall challenges at Camp Surrey.
My child will not yet be 10 years old during camp.

Additional Notes

By initialing, you are stating that you have read and agree to the Camp Surrey Standards Agreement *

By initialing, you are stating that you have read and agree to the Camp Surrey Standards Agreement *

By initialing, you are stating that you have read and agree to the Camp Surrey Photo/Video Agreement *

By initialing, you are stating that you have read and agree to the Camp Surrey Photo/Video Agreement *

By initialing, you are stating that you have read and agree to the Camp Surrey Medical Release/Parental Permission Form *

By initialing, you are stating that you have read and agree to the Camp Surrey Medical Release/Parental Permission Form *

By initialing, you are stating that you have read and agree to the Camp Surrey Climbing Wall Release & Waver Form *

By initialing, you are stating that you have read and agree to the Camp Surrey Climbing Wall Release & Waver Form *

Camper Signature *

Clear Signature

Parent/Guardian Signature *

Clear Signature

Payment

You will be redirected to the payment page. Please note your campers registration is NOT complete until payment has been received. Because space is limited, we're unable to hold registrations without payment.

Save and Resume Later

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

Copy Link

Email *

This content is neither created nor endorsed by WPForms.