2025 Day Camp Registration Form
Child's Name
*
First Name
Last Name
Child's Date of Birth/Age
*
Last Year of School Completed
*
T-Shirt Size
Parent/Guardian's Name
*
First Name
Last Name
Mailing and Physical Address
*
Home Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Home Church (if any)
In case of emergency, when parent/guardian can’t be reached, please contact:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Child
Any allergies, medical condition/special needs
Person responsible for picking up your child each evening at 3:00 PM:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please indicate below whether you grant permission for the child listed above to be photographed during the Day Camp on July 22-July 23, 2025. These photos may be shared in Facebook posts and on individual church websites.
I give my permission
I do not give permission
Signature
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