2017 Elementary Day Camp Registration

Name of First Child *
First Name
Middle
Last Name
Grade of First Child *
Child's shoe size?*
Child 1 Allergies:*
Child one allergies:
Name of Second Child
First Name
Middle
Last Name
Grade of Second Child
Child's shoe size?
Child 2 allergy question.
Child 2 allergies:
Name of Third Child
First Name
Middle
Last Name
Grade of Third Child
Child's shoe size?
Child 3 allergy question
Child 3 allergies:
Mailing Address
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Parent or Guardian *
First Name
Middle
Last Name
Work Phone*
Cell Phone*
Parent's Email Address*
The parent/guardian gives permission for their child to be part of the day camp program at Harbor Light Church. I hereby authorize the leaders of the group to take their child to a doctor or hospital for treatment in case of emergency.
Doctor's Name
Doctor's Phone Number
Health Insurance Company
The parent/guardian consents to have their child's picture taken during the day camp for marketing purposes.
Which Day Camp? *
If you do not want to attend the full week, which days will you attend?