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Registration Form
Children's Music Camp
June 2-7, 2019
6:00-8:30 PM
Completed K-6th Grade
Cost: FREE! (SIGN UP BEFORE MAY 20TH
TO RECEIVE A FREE T-SHIRT!)
Cleveland First Baptist Church
Cleveland, GA 30528
706-865-FBC3
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* Indicates required question
CHILD'S NAME
*
Your answer
PARENT/GUARDIAN NAME
*
Your answer
ADDRESS
*
Your answer
HOME PHONE
*
Your answer
WORK PHONE
*
Your answer
CELL PHONE
*
Your answer
EMAIL
*
Your answer
CHILD'S DATE OF BIRTH
MM
/
DD
/
YYYY
LAST GRADE COMPLETED IN SCHOOL
*
KINDERGARTEN
1ST GRADE
2ND GRADE
3RD GRADE
4TH GRADE
5TH GRADE
6TH GRADE
MEDICAL OR OTHER INFORMATION WE NEED TO KNOW. (PLEASE INCLUDE FOOD ALLERGIES
*
Your answer
EMERGENCY CONTACT NAME & NUMBER (OTHER THAN ABOVE)
*
Your answer
EMERGENCY CONTACT NAME & NUMBER
*
Your answer
WHO MAY PICK UP YOUR CHILD AT THE END OF EACH MUSIC CAMP DAY?
*
Your answer
DO YOU ATTEND CHURCH?
*
YES
NO
Required
IF SO WHERE?
Your answer
T-Shirt Size:
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
MAY WE HAVE PERMISSION TO PHOTOGRAPH YOUR CHILD?
*
YES
NO
Required
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