Riverwood Community Church

Kids Bible Camp Registration 2010

 

Please fill out form completely. Please note: Children must be age 4 as of 12/1/09 in order to be registered for the preschool class. Thank you!


Child's Last Name  
Child's First Name  
Street Address  
City    State
Zip Code  
Phone  
E-mail  
Home Church
Child's Date of Birth                  *MUST be age 4 as of 12/1/09
Grade Completed as of 6/2010  
Parent Name    Relationship to Child 
Please list any developmental, emotional, or physical challenges (including allergies):
Friend Request for Crew:
Emergency Contact #   Name and relationship to child?  
Authorized to be picked up by: 1. 2.   3.
Do you authorize Riverwood Community Church to use images of your child from High Seas Expedition? Yes  No
For security purposes, please type the following letters exactly as you see them: JEsUs