Fun Day Application

Application must be submitted before July 6th for consideration.

In alignment with CCK’s current health and safety policy, every child and adult attendee will be swab tested for COVID 19 upon arrival. A negative result is required to participate. Masks are not required.

Fun Day, July 15

Email*

Phone*

Address*

Street Address City State ZIP Code

Organization Affiliation*

Parent/Guardian*

Age*

Gender*

Ethnicity/Race*

Medical Conditions*

Food Allergies*

Parent/Guardian

Age

Gender

Ethnicity/Race

Medical Conditions

Food Allergies

Child 1 Name*

Child 1 Age*

Child 1 Gender*

Child 1 Ethnicity/Race*

Child 1 Medical Conditions*

Child 1 Food Allergies*

Child 2 Name

Child 2 Age

Child 2 Gender

Child 2 Ethnicity/Race

Child 2 Medical Conditions

Child 2 Food Allergies

Child 3 Name

Child 3 Age

Child 3 Gender

Child 3 Ethnicity/Race

Child 3 Medical Conditions

Child 3 Food Allergies

Child 4 Name

Child 4 Age

Child 4 Gender

Child 4 Ethnicity/Race

Child 4 Medical Conditions

Child 4 Food Allergies

Child 5 Name

Child 5 Age

Child 5 Gender

Child 5 Ethnicity/Race

Child 5 Medical Conditions

Child 5 Food Allergies

Child 6 Name

Child 6 Age

Child 6 Gender

Child 6 Ethnicity/Race

Child 6 Medical Conditions

Child 6 Food Allergies

Photography Release:*

Yes

In consideration of my/my children’s participation at The Center, and without any further consideration from The Center, I hereby grant permission to The Center, staff and affiliates to utilize my appearance, performance or voice in any and all manner and media throughout the world for the purpose of promotion, reporting or publication. The Center may use my/my children’s name, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. I understand that no royalty, fee or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph.

If you are having trouble with any part of this application, call CCK at 270-618-2900 and ask for Robin Frazier.

This field is for validation purposes and should be left unchanged.