Sports Camp Registration
PILLAR KIDS SPORTS CAMP
Indicates required field
Register for the Camp
There is no limit to the number of children that can participate per family but we do ask that you fill out a separate registration form for each participant.
Parent or Guardian's Name
Parent or Guardian's Email
Parent or Guardian's Phone Number
Is the Participant between 6 and 12 years old?
Choose a Sport
Additional Information: If your child has a condition or allergy we should know about please submit that information here.
APPROVED PICKUPS: Due to safety provisions, children will only be released to adults approved by the parent/guardian of the child. Please list any approved individuals, with their contact information. Photo ID must be provided upon pick-up.
Release Statement: I hereby give the staff of Pillar Church permission to see that my child, Receives any medical attention he/she may need while participating in the Pillar Kids Sports Camp event. I also release Pillar Church and its staff of any liability not caused by their negligence during the above activity. This includes the following:
The power to seek appropriate medical treatment or attention on behalf of the child as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits.
The power to authorize medical treatment or medical procedures in an emergency situation.
In case of emergency, I understand that every effort will be made to contact parents or guardians of minor registrants. However, if parents or guardians cannot be reached, I hereby give Pillar Church permission to act on my behalf in seeking and administering medical treatment should it be deemed necessary or advisable for the registrant’s health, safety and/or welfare.
I allow my child to be picked up only by any approved individuals that I have listed under the "Approved Pickups" section in the registration form.
About The Camp
The Pillar Kids Sports Camp is provided free of charge as a ministry of Pillar Church in Dumfries for children ages 6-12. At the camp, caring and knowledgeable coaches and mentors will teach the fundamentals of four different sports: basketball, baseball/softball, football and soccer.
Triangle Elementary School
3615 Lionsfield Rd, Triangle, VA 22172
July 8th, 2019- July 11th, 2019
(Monday - Thursday)
6:15 PM-8:30 PM
Sports Camp Location
3615 Lions Field Road
Triangle, VA 22026