St. Stephen Reformed Church Summer Kids Camp
Mystery at the Lighthouse!
July 23rd-27th, 2018
249 E Main St, New Holland, PA 17557
Contact us at (717) 354-7871 or ftitus@ststephenpca.org
Email address *
Family's Last Name *
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Name of the enrolled child's mother
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Name of the enrolled child's father
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Home Address *
Enter the complete and exact street address for the child's home (ex: 249 E Main St, New Holland, PA 17557)
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Primary Contact Phone Number *
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Primary Contact Email *
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How Many Children To Be Enrolled? *
Please enter how the number of kids you will be enrolling
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Name, Age, Grade Completed and DOB *
**If your child is 4 or 5 years old, and has not completed kindergarten, they will be placed on a waiting list, due to a full class. There is still space for other ages.** For each child you enroll, please enter their full name, their age (as July 23rd 2018), grade completed (as July 23rd 2018) and date of birth.
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GROUPING INFORMATION
4 & 5 year olds will have their own group. Ages 6 -11 years old are grouped by age/grade equivalent which can fluctuate slightly depending on registration numbers.
Health Concerns - Food Allergies
If you have any health concerns for you child, please give the child's name and the concern you have. Leave blank if you have no concerns
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Friday Luncheon *
Number of guests accompanying the registered child/children (leave blank if none)
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Emergency Contacts (AFTER parents have been tried) *
Please enter an emergency contact in the line provided. Enter the contact's full name, phone number, and relation to your enrolled child/children.
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*
Please enter a second emergency contact. Enter the contact's full name, phone number, and relation to your enrolled child/children.
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