TRC VBS 2024 Registration Form

CAMP 2024 Registration Form

Please complete the below registration form. A team member will be in contact with you.
Child's Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Name*

PrefixFirst NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Preferred Medical Facility (Optional)
Name of Physician/Pediatrician (Optional)

First NameLast Name
Phone Number (Optional)
Please enter a valid phone number.
Any Allergies or Medical Conditions?*

YesNo
Please give details
Do you want to add something about your child? (Optional)
Please upload a profile picture of the child (Optional)

Cancelof
I, undersigned, agree with the following statements:*

I am the parent/guardian of the child indicated above.If emergency medical care is needed and I am unavailable, I authorize the supervising teacher to seek medical treatment for my child.I am giving my permission to take my child's pictures for classroom projects and post them on the church website.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

CAMP 2024 Registration Form