Bilberry Creek Baptist Church
480 Charlemagne Blvd, Orleans 613-824-3131
Vacation Bible Adventure -- Ready, Set, Move!
August 21-25, 2023 9am-12pm
Camper Registration Form
Camper Category
*
Please Select
Camper (Grade K-6)
Leader in Training (Grade 7-10)
Volunteer (Up to 18 years old)
Camper's Name
*
First Name
Last Name
Gender
Please Select
Boy
Girl
School grade in September
*
Please Select
SK
1
2
3
4
5
6
7-10
11-12
Birth Date
*
/
Year
/
Month
Day
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
PG First Name
PG Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Relationship to Camper
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name(s) of people authorized to pick up and/or drop off my child. (Add arrangement details as necessary)
*
Church Currently Addending
Siblings attending camp (name and grade in September)
Describe any health conditions or concerns
List your child's allergies, if any
Child's health card number (optional)
NOTE: A camper's fee of $25 applies to all campers.
Parent/Guardian Signature
Continue
Continue
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