Summer Camp Registration

Vacation Bibles School Registration

Complete the registration details for your camper. A $10 registration fee is requested, but no one will be turned away who is unable to pay. Contact 322-3874 for further details.
Participant Full Name

First NameLast Name
Participant Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Participant Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the participant have any allergies or medical conditions?
Special Requests or Additional Information
I agree that my child/children can attend the summer program at East Street Gospel Chapel Fellowship Hall and take part in all activities in relation to this program 2026 and in so doing wave any liability for injuries my child may suffer while participating in the program.
All children must be collected by 1:00pm
Signature
Should be Empty:

Vacation Bibles School Registration