Sing Praise and Splash Preschool Daycamp June 16 and 18
Registration Form
Payment should be submitted separately via the Church Center link
Child's Name
First Name
Last Name
Child's Birth Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Age at Date of Camp
Gender
Female
Male
Allergies, Medical and Special Needs:
Parent/Guardian Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Primary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Work 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.
Emergency Contact 1 (if parent/guardian cannot be reached)
First Name
Last Name
Emergency Contact 1 telephone number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact 2
First Name
Last Name
Emergency Contact 2 telephone number
Please enter a valid phone number.
Format: (000) 000-0000.
Approved Pick Up 1
First Name
Last Name
Approved Pick up 1 Driver's license number
Approved Pick Up 2
First Name
Last Name
Approved Pick Up 2 Driver's license number
I hereby give my consent for my child to participate in water activities
Yes
No
May we have your permission to use your child's photo in church publications?
Yes
No
Emergency Medical Attention
Physician Name
Emergency Medical Attention
Physician telephone number
Emergency Medical Hospital
Facility name and address
Submit
Should be Empty: