Kids Mission Camp Registration
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child gender *
Required
Age *
Your answer
Birthday *
MM
/
DD
/
YYYY
Last Grade Completed
Your answer
Parent First Name *
Your answer
Parent Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone Number *
Your answer
Add'l Phone
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Email *
Your answer
Home Church
Your answer
Allergies or Medical Conditions *
Your answer
Emergency Contact (if parent unavailable) *
Your answer
Emergency Phone *
Your answer
Relationship to Child
Your answer
My child plans to carpool with
Your answer
I can carpool how many additional
Your answer
Carpool to/from
I am interested in Volunteering for the week
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