Alpha Bits Camp Registration

Western Buckeye Camp Registration
Alpha Bits Camp

June 11-12 / Kindergarten - 1st Grades
Email*
Parent/Guardian Email
Email (short text)
Parent/ Guardian Email address
- Camper's Name*
  
  First NameLast Name
- Camper's Gender*
  
  MaleFemale
- Grade entering this fall
- Address*
- City*
- State*
- Zip Code*
- Parent/ Guardian Name(s)*
- Church Name*
- Church Town
- Camper Pick Up Person*
  If you're unsure, put anyone that could pick up
- Home Phone Number*
- Emergency Contact Name*
- Emergency Contact Phone Number*
- Physical Limitations*
- Allergies*
- Food Allergies*
  If your camper has a food allergy, please bring some food to store with campers name just in case.
- Prescriptions *
- Date of Last Tetanus Shot
- Can your child have OTC medication?*
  
  YesNo
- Insurance Company*
- Policy Holder*
- Group/ Policy Number*
- City*
- State*
- I give permission for the camp to use pictures of my child for advertising purposes.*
  
  YesNo
- I certify that all of the information on this form is true to the best of my knowledge.*
  
  YesNo
- I have read and agree to all of the camp's rules and policies.*
  
  YesNo
- Person completing form*
- Upon completion of this form, if a registration fee is required, you will be redirected to a payment page. Please note that your registration is not confirmed until you complete that payment. If you have any questions, contact info@westernbuckeyecamp.org
  
  If you have a discount code, please enter it below before proceeding.
- I understand*
  
  Yes
- Discount Code
Should be Empty:

Western Buckeye Camp Registration

Alpha Bits Camp