*Participant's First Name: |
__________________________________ |
*Participant's Last Name: |
__________________________________ |
*Preferred Name for Name Tag: |
__________________________________ |
*Birthday: |
__________________________________ |
*Last Grade Completed: |
__________________________________ |
Gender: |
Male Female (circle one) |
*Track 1st Choice: |
__________________________________ |
*2nd Choice Track: |
__________________________________ |
*Track Choice 3: |
__________________________________ |
*Join us For Dinner!: |
Every Day Only Some Days No (circle one) |
May we have permission to photograph your child?: |
Yes No (circle one) |
May we have permission to use your child's photograph in church publications?: |
Yes No (circle one) |
Allergies, Medical, & Special Needs: |
|
*Parent/Guardian Name: |
__________________________________ |
*Address: |
__________________________________ |
*City: |
__________________________________ |
*State: |
__________________________________ |
*Zip: |
__________________________________ |
Primary Phone: |
(______)______-________ |
Work Phone: |
(______)______-________ |
*Cell Phone: |
(______)______-________ |
*Email: |
__________________________________ |
*Join us For Parent Camp?: |
Yes - All Nights Yes - Some Nights No (circle one) |
*Emergency Contact Name (1): |
__________________________________ |
*Emergency Contact Phone (1): |
(______)______-________ |
Emergency Contact Name (2): |
__________________________________ |
Emergency Contact Phone (2): |
(______)______-________ |
*Authorized Pickup #1: |
__________________________________ |
Cell Phone - Authorized Pickup #1: |
(______)______-________ |
Authorized Pickup #2: |
__________________________________ |
Cell Phone - Authorized Pickup #2: |
(______)______-________ |
Do you attend Church?: |
Yes No (circle one) |
If so, where?: |
__________________________________ |
Comments: |
|