Kids Camp Registration Form

Registration Form

Fill out the form carefully for registration
Student #1 Name

First NameLast Name
Student #2 Name

First NameMiddle NameLast Name
Student #3 Name

First NameMiddle NameLast Name
Student #1 Birth Date

MonthDayYear
Student #1 Gender
Student #1 Grade in Fall
Student #2 Birth Date

MonthDayYear
Student #2 Gender
Student #2 Grade in Fall
Student #3 Birth Date

MonthDayYear
Student #3 Gender
Student #3 Grade in Fall
Parent/Guardian Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email
example@example.com
Emergency Contact Number
Format: (000) 000-0000.
Do you give St. John's UCC permission to post pictures onto our website and social media that may include your student(s)
How many from your family will be joining us for lunch at noon?
Does your student(s) have any food allergies or other information that you wish to share?
Signature
Should be Empty: