Summer Jam Registration

Summer Jam Registration 2026

Cottage Hill Baptist Church | June 1-4 | 9:00 a.m. - 12:00 p.m.
Summer Jam is for kids and preteens who have COMPLETED Kindergarten-6th Grade.

If you are volunteering at Summer Jam and are in need of childcare for younger children in your household, please complete the Summer Jam Volunteer Registration here.
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- Child 1: Name*
  
  First NameLast Name
- Child 1: Birthdate*
  
  MonthDayYear
- Child 1: Gender*
- Child 1: Allergies, Medical Information, or Special Needs
- Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeOther
- Child 1: Friend Request for Same-Grade Group:
  Please list accurate grade completed. If friend request is in a different grade, we will discuss options with you.
- Child 2: Name*
  
  First NameLast Name
- Child 2: Birthdate*
  
  MonthDayYear
- Child 2: Gender*
- Child 2: Allergies, Medical Information, or Special Needs
- Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeOther
- Child 2: Friend Request for Same-Grade Group:
  Please list accurate grade completed. If friend request is in a different grade, we will discuss options with you.
- Child 3: Name*
  
  First NameLast Name
- Child 3: Birthdate*
  
  MonthDayYear
- Child 3: Gender*
- Child 3: Allergies, Medical Information, or Special Needs
- Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeOther
- Child 3: Friend Request for Same-Grade Group:
  Please list accurate grade completed. If friend request is in a different grade, we will discuss options with you.
- Child 4: Name*
  
  First NameLast Name
- Child 4: Birthdate*
  
  MonthDayYear
- Child 4: Gender*
- Child 4: Allergies, Medical Information, or Special Needs
- Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeOther
- Child 4: Friend Request for Same-Grade Group:
  Please list accurate grade completed. If friend request is in a different grade, we will discuss options with you.
- Guardian 1: Name*
  
  First NameLast Name
- Guardian 1: Email*
  example@example.com
- Guardian 1: Phone Number*
  Format: (000) 000-0000.
- Guardian 2: Name
  
  First NameLast Name
- Guardian 2: Email
  example@example.com
- Guardian 2: Phone Number
  Format: (000) 000-0000.
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Additional Emergency Contact
  
  First NameLast Name
- Emergency Contact Relationship to Child
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Who else is allowed to pick up your child?
- Additional Comments or Questions
- I understand photos and videos of my child(ren) may be taken while participating in Cottage Hill Baptist Church events and may be used in any Cottage Hill Baptist Church publications.
- Should be Empty:

Summer Jam Registration 2026