Day Camp Registration

Please complete one form per child.
Click here if you choose to download application instead
Name of Child: *
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Grade Just Completed: *
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Birth Date: *
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Street Address: *
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City: *
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State: *
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Zip Code: *
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Home Phone: *
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Cell Phone:
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Email: *
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Parents Name: *
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Work Phone:
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Emergency Contact: *
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Phone Number: *
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Allergies or other Medical conditions:
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Name of Home Church:
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Name of Siblings attending and grade completed:
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Name of person who will drop-off and pick up your child: *
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Phone Number: *
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Please type the letters below. Please type the letters below.
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