PARENT/CAREGIVER INFORMATION

First Name *

Last Name *

Address *

City *

State *

AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY PR VI Other

Zip *

Parent Cell Number *

Parent Email *

Home church *

Is an older sibling attending Worship Arts Camp (Kind-Gr 5)? *

Yes

No

If so, please list name(s)

T-shirt availability/requested size is not guaranteed for any registration dated after 6/14/24.

CHILD INFORMATION (1)

First Name (1) *

Last Name (1) *

Birthdate (1) xx-xx-xxxx *

Gender (1) *

Male

Female

Camp Option (1)

Full Day (9 am to 4 pm)

Half Day (9 am to Noon)

Food or Other Allergies/special considerations including a need for sensory adaptations (1)

T-shirt size (1) *

Child XS

Child S (6-8)

Child M (10-12)

CHILD INFORMATION (2)

First Name (2)

Last Name (2)

Birthdate (2) xx-xx-xxxx

Gender (2)

Male

Female

Camp Option (2)

Full Day (9 am to 4 pm)

Half Day (9 am to Noon)

Food or Other Allergies/special considerations including a need for sensory adaptations (2)

T-shirt size (2)

Child XS

Child S (6-8)

Child M (10-12)

EMERGENCY CONTACT - if parent(s) cannot be reached

First & Last Name *

Phone Number *

Relationship to family (grandparent, neighbor, etc) *

I have read, discussed with my child(ren), and agree to the attached liability and behavior agreement. *

Yes

Liability/Permission/Behavior Agreement *

Liability, Permission and Behavior Agreement 2023_24.pdf

I want to be reminded