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Intersession Church Camp Registration
Unfortunately, we have limited spots in our program. Filling out this form DOES NOT guarantee a spot for your child. We will contact you through email to confirm your spot and location! You will need to fill out a form for each of your individual children.
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Student's legal name *
What school do you attend *
Student's grade level *
Any allergies *
Primary Caretaker Name: *
Primary Caretaker phone number: *
Primary Caretaker email *
Family's home address *
Who is approved to pick up your student *
List any security/custody issues with your student if any *
List any special needs (ADD, Asperger’s, Dyslexia, etc) if any *
Emergency contact name: *
Emergency contact phone number *
Do you have a church that you are a part of
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