Day Camp Sunday School Registration
Fill out one form per child. Any questions? Email office@staynerbic.com
Name of child *
Your answer
Child's gender: *
Date of birth: *
MM
/
DD
/
YYYY
Last school grade completed: *
Your answer
Street address and city: *
Your answer
Parent/caregiver's name: *
Your answer
Parent/caregiver's cellphone: *
Your answer
Home e-mail address: *
Your answer
Allergies/medical conditions or other concerns:
Your answer
In case of emergency, contact: *
Your answer
Phone number of emergency contact:
Your answer
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