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Bible Camp Registration Form
Cost for Camp: $20 (Please give to Shilea Stadler or Amber Graves)
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* Indicates required question
Child's Name (First & Last)
*
Your answer
Name Child Prefers
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Child’s Grade for 2021-2022 School Year
*
K
1st
2nd
3rd
4th
5th
6th
Child’s T-Shirt Size
*
YXS
YS
YM
YL
YXL
AS
AM
AL
AXL
Parent’s Name
*
Your answer
Address
*
Your answer
City
*
Your answer
Zip
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Child Care Provider’s Name & Phone Number
*
Your answer
Please list the name(s) and phone number(s) of anyone besides you who is allowed to pick up your child.
*
Your answer
Does your child have any allergies or diet restrictions? Please list AND if allergies – please list severity (Ex. Life threatening, moderate, occasionally, etc.).
*
Your answer
Does your child have an EpiPen?
*
Yes
No
Do we have your consent to take/post pictures of your child on social media?
*
Yes
No
Is there any other important information you need to share with us?
*
Your answer
Would you like more information about our church?
*
Yes
No
If yes, by which method?
Email
Mail
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