KanTex 2025 District Youth Camp Student Registration

Primary Parent/Guardian Contact Information

Name

This address will receive a confirmation email

Cell Phone

Secondary Parent/Guardian Contact Information (Optional)

Name

Cell Phone

Student Information

Name

Gender

Address

Birth Date

Primary Phone

Student Email

This address will receive a confirmation email

Grade (Fall 25)

T Shirt Size

Roommate Request

Waiver

I agree to the terms set forth in the student waiver below.

STUDENT WAIVER

Security Policy

I agree to the terms set forth in the security policy below.

CAMP SECURITY POLICY

Medical Information

Emergency Contact Name

Emergency Contact Phone

Name Of Doctor

Phone Of Doctor

Insurance Company

Subscriber Name

Subscriber Date Of Birth

Policy ID #

Group #

Please list any medical information about your child that your church/KanTex Camp should be aware of.

Please list prescription medications your student will be bringing to camp. DRUG NAME, DOSAGE, WHEN TO GIVE (BREAKFAST, LUNCH, DINNER, OR BEDTIME), AND ANY COMMENTS CONCERNING EACH MEDICATION. (Each church is responsible for dispensing all medications to their students.)

Please list all over the counter and/or prescription drugs your child is ALLERGIC to:

Please list all over the counter drugs your child is NOT allowed to have:

A registration confirmation will be sent to the email address provided for the primary parent and the registered student. Please check your email (including spam folders) before submitting this form more than once. Your confirmation will include a link to the camp packing list and security policy.

Note: Only Parent, Legal guardians or persons 18 years of age or older can enter information for this event. If you are not at least 18 years old and you wish to register, you will need to have a parent or guardian fill in the registration form.

Description

Please complete a camp registration form for each student you are registering. Only parents, legal guardians or persons 18 years of age and older can complete the camp registration.

KanTex Camp is a joint youth camp between several churches of the Kansas and Texas Districts of the Wesleyan Church.

Dates: June 23-27, 2025

Pricing:
$250 by June 1
$275 after June 1
Note: Your church may set an earlier deadline for payment.

Make payments to the church you are attending with.

KanTex 2025 District Youth Camp Student Registration

Description

Please Fix the Following