Canyon Bible Church Day Camp: Being BIG in God’s Eyes Registration Form For the dates of July 25-29, 2016

Child’s name: ________________________________ DOB: ____________ Grade:______

Parent’s Name: __________________________ Parent’s Main phone #: ________________________________

Mailing Address: ____________________________________________________________________________

1st Emergency Contact: _______________________ Relationship to Child: __________________

1st Emergency Phone: ________________________

2nd Emergency Contact: ______________________ Relationship to Child: __________________

2nd Emergency Phone: _______________________

Parent’s Email: _________________________________

Child’s Food Allergies:_____________________________________________________________________________

Name of church you attend: _________________________________________________

If your child is visiting or a guest, please circle how you heard about our Day Camp:

Friend: ____________________________ newspaper flyer church website

Please list anyone (other than yourself) that is allowed to pick your child up.

Name: ______________________________Phone: ___________________ Relationship: _______________________

Name: ______________________________Phone: ___________________ Relationship: _______________________

Name: ______________________________Phone: ___________________ Relationship: _______________________

• We will be serving a snack each day for your child according to the food allergy section you have made available to us using this form.

• We will require you to sign your child in and out each day inside the building. Your child will be released only to those listed by you.

• If everything here is correct, please sign below Parents Signature: ___________________________________________________________

Canyon Bible Church of Prescott: 122 N. Cortez St. Suite 317, Prescott, AZ 86301 928-237-9520 admin@canyonprescott.org