Children's Overnighter 2026

This overnighter is for 3rd, 4th, and 5th graders. The overnighter starts at 7 PM on Friday March 13th and ends at 9 AM on Saturday March 14th. This is a fun-filled and high-energy event with lots of crazy games and excitement! The overnighter will include late-night pizza and a continental breakfast.

Name

This address will receive a confirmation email

Address

Phone

Birthdate

Gender

Current Grade

Parent One First and Last Name

Parent One Phone Number

Parent One Phone

Parent Two First and Last Name

Parent Two Phone Number

Parent Two Phone

Child Lives With

If other is selected, please list name and relationship

Who has permission to pick up your child from this event? Parent names must be listed.

Health and Emergency Contact Information

My child has physical or emotional conditions

Please list physical or emotional conditions

My child has allergies or reactions/current medications

Please list allergies or reactions/current medications

My child has special dietary needs

Please list special dietary needs. For example, my child has a dairy allergy, peanut allergy, etc.

My child is current on all immunizations

Year of last tetanus shot

My child may have (if needed)

Tylenol Ibuprofen Benadryl (for allergic reaction) Claritin None

My child wears Glasses Contact lenses

Insurance Company

Insurance policy number

Emergency contact (other than parent)

Emergency contact's phone number

Emergency contact's relationship to child

Permission for Participation

In signing this application, I hereby certify that the above information is correct and give permission for the use of photographs and/or videos including my son/daughter for publicity purposes for the Children’s Ministry at First Christian Church.

I certify that the child named above is in good health and able to participate in all activities. I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.

I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. Coverage by First Christian Church through its accident policy will be used, as a backup for what my family’s insurance does not cover.

I understand all reasonable safety precautions will be taken at all times by First Christian Church and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold First Christian Church, its leaders, employees and volunteer staff liable for damages, losses, diseases or injuries incurred by the subject of this form.

I agree and give permission for my child to participate

Yes

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Children's Overnighter 2026

Description

Please Fix the Following