CentriKid Camp 2026 (rising 3-6 grade)

CentriKid is a high-energy, five-day camp for rising 3rd-6th graders (26/27 school year). Get ready for a week of fun activities, worship, and Bible teaching!

Click HERE to find out more about CentriKid camp!

At CentriKid 2026, kids will open the pages of God's Word and discover how He is the author of salvation, truth, joy, and the future. Join us for a journey you'll never forget, and experience THE STORYTELLER!

Our key verse is Romans 11:36:
"For from Him and through Him and to Him are all things. To Him be the glory forever. Amen."

It's gonna be fun, we can't wait to see you there!

Child Information

Please fill out the child's information below.

Name

Gender

Date of Birth

Grade (26/27 School Year)

Primary Address

Child's Phone Number

TShirt Size

Medical & Insurance Information

Please fill out child's medical and insurance information below.

Insurance Company

Primary Named on Insurance Policy

Group Policy/Member Number

Child's Primary Physician

Physician's Phone Number

Allergies (Please list all allergies and diet restrictions here; ex: Peanuts, Latex, Amoxicillin, etc)

Is there anything else Wellspring or CentriKid should be made aware of? (medications, physical limitations, sports restrictions, medical history, behavior diagnoses)

Primary Parent/Guardian Information

Please fill out the primary parent or guardian's information here.

Name

Phone

This address will receive a confirmation email

Address (if different from child's)

Relationship to child

If "Other" please describe relationship to child here.

Secondary Parent/Guardian/Emergency Contact Information

Please fill out the secondary parent/guardian or other emergency contact information here.

Name

Phone

Address (if different from child and primary parent/guardian)

Relationship to child

If "Other" please describe relationship to child here.

Parent/Guardian Authorization, Consent, and Release

I, ____________________________, parent/guardian of ______________________________, hereby grant my permission for the above-named child to participate in CentriKid, sponsored by Wellspring Church (the “Church”), July 20-24, 2026 (the “Event”).
I understand the Event may include, but is not limited to the following: transportation provided by the Church to and from the Event, meals, and lodging. Recreation and activities during the event may include, but are not limited to the following: Bible teaching, worship, prayer, indoor and outdoor activities including water activities and physical exercise.

I understand it is my obligation to inform the Church of any and all health considerations or medical conditions that would restrict my child’s participation in any and all activities while in the care of the Church. Should the need for medical attention arise I understand the Church will attempt to contact me as soon as practicable under the circumstances.

In cases of emergency, I further consent to the examination and treatment of my child by medical personnel as deemed necessary by such personnel. I agree to pay for any and all resulting medical expenses. I agree to waive, forever discharge, covenant not to sue and agree to hold harmless all Event volunteers and the Church, their agents, representatives, employees, sponsors, successors and assigns (“the Released Parties”), from all liability, claims, demands, losses or damages on account of or caused by, whether actual or alleged, in whole or in part, any act or omission of the Released Parties in connection with my child’s participation in the Event.

I acknowledge by signing this document I am waiving my right to maintain a lawsuit against the Released Parties on the basis of any claim from which I have released them herein. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions remain in full force and effect. I have fully informed myself as to the contents of this PARENTAL AUTHORIZATION, CONSENT AND RELEASE by reading it before I signed it.

By typing your full name and the current date, you are electronically signing this form and acknowledging that you have read the above Parent/Guardian Authorization, Consent and Release, that all repsonses in this form are true, and that your online consent is equivalent to a binding legal signature.

Full Parent/Guardian Name

Current Date

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

CentriKid Camp 2026 (rising 3-6 grade)

Description

Please Fix the Following