CAMP COUNSELOR FORM

CAMP COUNSELOR INFORMATION

Counselor first name*

Counselor last name*

Email*

Parent/ Guardian Name(s)*

Parent email*

Parent Phone*

Tshirt Size*

Adult S

Adult M

Adult L

Adult XL

Adult XXL

Please choose which your child will help with*

Kids Camp Daytime only

Kids Camp Night will stay overnight only

Middle School retreat only

Kids Camp Daytime AND Middle School retreat

Kids Camp Overnight AND Middle School retreat

Are there any allergies we need to be aware of?*

Are there any medical conditions we need to be aware of?*

Emergency Contact 1*

Emergency Contact 1 Phone*

Emergency Contact 2*

Emergency Contact 2 Phone*

I understand my child will be photographed and filmed while at Camp Glow. These photos will be used for social media and other web based advertising

If you need to reach your child during camp time please try to contact Tony or Lauren Wagoner. We encourage counselors to be off and away from phones as much as possible. If they need to pack a phone, please instruct them that it cannot be out during camp.

The liability waiver must be completed prior to camp. Your child will not be able to attend without one

I understand that if my child is a counselor at the middle school retreat and/or stays overnight during the kids' summer camp, they will need to pay a fee for meals

Payment

Please fill out the following portion if your child will be staying overnight during our kids' camp week and/or middle school retreat

Counselor first name*

Counselor last name*

Email*

Staying at middle school retreat

$50

Staying overnight at Kids' Camp

$100

Staying at both

$125

CAMP KINDLING
WITH MAKER AND KIN

3350 CAMP JULIA ROAD
KANNAPOLIS NC 28083

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