PBC Kidz Kamp Enrollment 2018
**IMPORTANT** After completing the form for your family you will be given a link to a waiver which must be printed, completed (with signature) and turned in upon arrival. If you are unable to print the document, copies will be provided at check-in.
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address
Your answer
Do you attend church regularly?
Name of church you attend:
Your answer
Emergency Contact #1 *
Full Name and Phone Number
Your answer
Emergency Contact #2 *
Full Name and Phone Number
Your answer
My child(ren) may be picked up by: *
Please list the names of those you authorize to pick up your child(ren)
Your answer
Child #1
First Name *
Your answer
Last Name *
Your answer
Grade Just Completed *
T-Shirt Size *
Special Needs or Allergies
Please let us know about any allergies or special needs we need to be aware of for this child during KidzKamp time.
Your answer
Child #2
First Name
Your answer
Last Name
Your answer
Grade Just Completed
T-Shirt Size
Special Needs or Allergies
Please let us know about any allergies or special needs we need to be aware of for this child during KidzKamp time.
Your answer
Child #3
First Name
Your answer
Last Name
Your answer
Grade Just Completed
T-Shirt Size
Special Needs or Allergies
Please let us know about any allergies or special needs we need to be aware of for this child during KidzKamp time.
Your answer
Child #4
First Name
Your answer
Last Name
Your answer
Grade Just Completed
T-Shirt Size
Special Needs or Allergies
Please let us know about any allergies or special needs we need to be aware of for this child during KidzKamp time.
Your answer
Child #5
First Name
Your answer
Last Name
Your answer
Grade Just Completed
T-Shirt Size
Special Needs or Allergies
Please let us know about any allergies or special needs we need to be aware of for this child during KidzKamp time.
Your answer
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