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Summer Camp Registration
June 17-21 9:00AM-12:00noon
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* Indicates required question
Email
*
Your email
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Age/Grade (grade just completed)
*
4 years
5 years (Has not completed Kindergarten)
Kindergarten
1st
2nd
3rd
4th
5th
Parent/Guardian's Names
*
Your answer
Parent/Guardian's Phone Number
*
Your answer
Emergency Contact's Name (after parents)
*
Your answer
Emergency Contact's Number (after parents)
*
Your answer
Child's Address:
*
Your answer
Allergies or Food Sensitivities
*
Your answer
Any other information you feel your child's teacher will need to know?
Your answer
List all people who can pick your child up from camp.
*
Your answer
May PCBC use your child's picture on social media and our website to promote our children's ministry?
*
yes
no
Shirt Size
*
youth XS (if available)
youth S
youth M
youth L
youth XL
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Adult XXXL
Children will be given a shirt if they are registered before May 19 at no cost. If you would like to order another shirt , please write sizes. $15.00 per shirt for additional shirts.
Your answer
Do you have a church home? check all that apply (optional)
Yes, I am a member of a church and attend regularly.
Yes, I am a member of a church but do not attend regularly.
No, but I am looking for a church home
No, and I am not looking for a church home at this time.
Clear selection
Name of Church (optional)
Your answer
How did you hear about our Summer Camp? (optional)
Your answer
A copy of your responses will be emailed to the address you provided.
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