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Camp Cyokamo Registration Form
Community Christian Church - Fort Scott, KS
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Before you start, you will need your HEALTH INSURANCE & PHYSICIANS CONTACT INFO on page 2 of this form!
First Name:
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Your answer
Last Name:
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Your answer
Gender
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Female
Male
Age:
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Grade Entering:
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K
1st
2nd
3rd
4th
5th
6th
7th
8th
Freshmen
Sophomore
Junior
Senior
2019 Grad
Address:
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Your answer
City:
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Your answer
State:
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Your answer
Zip:
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Your answer
Shirt Size:
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YS
YM
YL
AS
AM
AL
AXL
A2XL
A3XL
Have you been baptized?
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Yes
No
Parent/Guardian #1 Name:
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Your answer
Parent/Guardian #1 Phone:
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Your answer
Parent Guardian #1 Email:
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Your answer
Parent/Guardian #2 Name:
Your answer
Parent/Guardian #2 Phone:
Your answer
Emergency Contact Name:
*
Your answer
Emergency Contact Phone:
*
Your answer
Emergency Contact Relationship:
*
Your answer
Child is Attending the Following Camp:
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Elementary
Junior High
High School
Child is Attending with CCC:
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Paul Martin/Kara Martin
Ian Johnson
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