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2017 Zion Summer Camp Registration
One form MUST be completed per camper. Registration IS NOT valid without $100 deposit. Final payment due 5/31
Email address *
#ZBCBaltimore
Camper Information
Name *
Last Name, First Name
Your answer
Address *
Number, Street, Unit, City, State, Zip Code
Your answer
Date of Birth *
MM/DD/YYYY
Your answer
Gender *
School Name *
Your answer
Registration Openings
Please note registration is time stamped and will be HONORED on a first come, first served basis. Registration fee MUST be paid to be valid If wait listed your registration fee is REFUNDABLE.
Grade Entering August 2017 *
Date of Last Tetanus Shot *
MM/DD/YYYY
Your answer
Medical Concerns *
Type "NONE" if no issues. Asthma pumps are REQUIRED for any scholar with asthma.
Your answer
Mother/Guardian Contact Information *
First & Last Name
Your answer
Cell Phone *
Your answer
Work Phone *
Your answer
Email Address *
Your answer
Father/Guardian Contact Information *
First & Last Name
Your answer
Cell Phone *
Your answer
Work Phone *
Your answer
Email *
Your answer
Emergency Contact #1 *
Name & Cell Phone #
Your answer
Emergency Contact #2 *
Name & Cell Phone #
Your answer
General Information
How did you hear about us? *
Please indicate Facebook, Instagram, Church, Personal Referral, or OTHER
Will you need before or aftercare? *
Please indicate ONLY Before, ONLY After, or BOTH if needed
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