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 [email protected]
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