St. Charles Bible Camp Pre-Registration
For any questions, please contact Michelle Henderson:
413-464-2194 or Ccdstcharles@gmail.com
Name of person filling out request:
First Name
Last Name
Your E-mail:
example@example.com
Your Contact Number:
How many children would you like to pre-register?
Please Select
1
2
3
4
Days interested in attending:
Tuesday 8/23
Wednesday 8/24
Thursday 8-/25
Friday8/26
Full Week
Child’s Name:
First Name
Last Name
Child's Age:
Child's Date of Birth:
-
Month
-
Day
Year
Child's Last Grade Completed:
Child 2’s Name:
First Name
Last Name
Child 2's Age:
Child 2's Date of Birth:
-
Month
-
Day
Year
Child 2's Last Grade Completed:
Child 3’s Name:
First Name
Last Name
Child 3's Age:
Child 3's Date of Birth:
-
Month
-
Day
Year
Child 3's Last Grade Completed:
Child 4’s Name:
First Name
Last Name
Child 4's Date of Birth:
-
Month
-
Day
Year
Child 4's Age:
Child 4's Last Grade Completed:
Special Instructions
Pre-Register
Should be Empty: