Summer Camp Registration

Child's Name*
First Last
Age*
Date of Birth*
Month
Day
Year
Grade Just Completed:*
If registering before the end of the school year, use current grade.
Gender*
T-Shirt Size*
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Emergency Contact Name 1:*
First Last
Emergency Contact Relationship 1:*
Emergency Contact Phone 1:*
Emergency Contact Name 2:*
First Last
Emergency Contact Relationship 2:*
Emergency Contact Phone 2:*
Does Your Child Have Allergies?*
- Yes
- No
If Yes to Allergies please specify
Any special needs?
Check each week you would like for your child to attend.*
***** CAMPS ARE FOR FULL WEEKS ONLY THIS YEAR AND WILL BE FILLED ON A FIRST COME, FIRST SERVER BASIS. WE WILL EMAIL YOU BACK WITHIN 3 BUSINESS DAYS TO COMFIRM YOUR SPOT. ***** Camps are for Boys and Girls that are "RISING 1ST GRADERS TO GRADUATED 5TH GRADERS". All Camps are Mon-Fri 8am-5pm and are $150 per week.
- Week 1 - June 19th-23th (20th-Gem Mine)
- Week 2 - June 26th-30th (27th-Asheboro Zoo)
- NO CAMP WEEK OF July 3rd-Jul 7th
- Week 3 - July 10th-July 14th (No field trip)
- Week 4 - July 17th-21st (18th-Grandfather Mtn)
- Week 5 - July 24th-28th (25th-Lazy 5 Ranch)
- Week 6 - July 31st-August 4th (The Block - tentative 8/1)
I understand that images of my child may be captured and used through video, photo and digital camera, to be used solely for the purposes of promotional material and publications, and I waive any rights of compensation or ownership thereto.*
- Yes
Name of person registering child for Summer Camp*
Email of person registering child for Summer Camp*
Do you have a church home?*
- Yes
- No
If Yes, where?

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