March 1, 2015—Today's Discipleship class has been canceled due to the weather.

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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