PK/MK Summer Splash 2026

PK/MK Summer Splash
Event Details

Date: Thursday, June 18
Time: 11:30 AM – 3:30 PM
Location: Virginia Church of God Campground (8018 Angel Ln, Roanoke, VA)

Additional Information:

-Open to students in 1st–12th grade
-Lunch will be provided
-A completed liability waiver is required for all participants
Student Information

Please complete a separate registration form for each student.
Student Name

First NameLast Name
Church
Age
Date of Birth

MonthDayYear
Date
Grade/Level
Gender
Medical Information
Date of last Tetanus Shot

MonthDayYear
Date
Please let us know if your student has any allergies, existing illnesses or any medical conditions.
Can your student swim independently? If not, will they need to wear a flotation device while in the water?
Is your student currently taking any medication? If yes, please provide the name and its purpose?
Is Student Covered by Medical Insurance?
Name of Insurance Carrier
If no, please type n/a in the box above
Policy Number
If no, please type n/a in the box above
Doctor's Name or Medical Clinic
Doctor's Phone Number

Area CodePhone Number

Student Registration Fee$10.00

Chaperone Registration Free

Please indicate how many chaperones will be attending below.

Quantity

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

PK/MK Summer Splash