2025 Regional Camp Meeting Childcare Registration Form
Please note that child care will ONLY be provided for children between ages 3 - 11.
PARENT INFORMATION
Primary Parent Contact's Name
*
First Name
Last Name
Primary Contact's Email Address
*
example@example.com
Primary Contact Phone Number
*
Please enter a valid phone number.
Church Name
*
Please Select
CE AKRON
CE ALLEN
CE ARLINGTON
CE ARLINGTON YOUTH CHURCH
CE ATLANTA
CE AURORA
CE AVON
CE BROADWAY
CE BROOKFIELD
CE CARMEL
CE CHARLOTTE
CE CHICAGO
CE CHICAGO SOUTH
CE CINCINNATI
CE COLUMBIA
CE COLUMBUS
CE COLUMBUS 2
CE COLUMBUS, INDIANA
CE CORPUS CHRISTI
CE DALLAS
CE DALLAS YOUTH CHURCH
CE DALLAS CENTRAL
CE DECATUR
CE DELAWARE
CE DESOTO
CE DULUTH
CE DUNCANVILLE
CE DUNWOODY
CE DURHAM
CE FLORIDA
CE FORT WASHINGTON
CE FRISCO
CE GAINESVILLE
CE GILBERT
CE HAMILTON
CE HAMPTON ROADS
CE INDIANAPOLIS
CE INDY-WEST
CE IRVING
CE KILEEN
CE LAUREL
CE LAWRENCE
CE MADISON
CE MANSFIELD
CE MARIETTA
CE MASSACHUSETTS
CE MERRILLVILLE
CE MICHIGAN
CE MILWAUKEE
CE MINNESOTA
CE NASHVILLE
CE NORTH DALLAS
CE NORTHSHORE
CE OREGON
CE PFLUGERVILLE
CE PHILADELPHIA
CE PITTSBURGH
CE PLAINFIELD
CE PLANO
CE RALEIGH
CE READING
CE RICHARDSON
CE ROCKHILL
CE SAN ANTONIO
CE SAN ANTONIO CENTRAL
CE SOUTHFIELD
CE STONE MOUNTAIN
CE TRAVIS
CE TULSA
CE UPPER DARBY
Name of Pastor
*
Additional Adult Authorized to Pick Up Your Child
First Name
Last Name
Secondary Phone Number
Please enter a valid phone number.
CHILD'S INFORMATION
How many children would you like to check-in?
*
Please Select
1
2
3
4
Child 1 Name
*
First Name
Last Name
Please enter Child 1 Date of Birth
*
-
Month
-
Day
Year
Date
Child 1 Age
*
Child 1 Gender
*
Male
Female
Any Allergies/ Dietary Restrictions for Child 1?
Is your child 1 potty trained?
*
Yes
No
Any special needs or concerns you would like to share regarding your child?
Child 2 Name
*
First Name
Last Name
Please enter Child 2 Date of Birth
*
-
Month
-
Day
Year
Date
Child 2 Age
*
Child 2 Gender
*
Male
Female
Any Allergies/ Dietary Restrictions for Child 2?
Is your child 2 potty trained?
*
Yes
No
Any special needs or concerns you would like to share regarding your child 2?
Child 3 Name
*
First Name
Last Name
Please enter Child 3 Date of Birth
*
-
Month
-
Day
Year
Date
Child 3 Age
*
Child 3 Gender
*
Male
Female
Any Allergies/ Dietary Restrictions for Child 3?
Is your child 3 potty trained?
*
Yes
No
Any special needs or concerns you would like to share regarding your child 3?
Child 4 Name
*
First Name
Last Name
Please enter Child 4 Date of Birth
*
-
Month
-
Day
Year
Date
Child 4 Age
*
Child 4 Gender
*
Male
Female
Any Allergies/ Dietary Restrictions for Child 4?
Is your child 4 potty trained?
*
Yes
No
Any special needs or concerns you would like to share regarding your child 4?
Submit
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