Register Now
Come join us for an exploration this summer!!
June 18-20, 2018
9:00am - 11:30am
Ages 5-10

It's time to get your child signed up. Simply submit this online registration form. Please submit one registration form per child. If you have any questions, contact the office at 610-942-2640.

Online Registration closes 6/11/2018

Child's Name (First and Last): *
Your answer
Child's Gender: *
Required
Child's Age: *
Child's Date of Birth: *
MM
/
DD
/
YYYY
Name of Parent(s): *
Your answer
Street Address *
Your answer
City, State Zip *
Your answer
Home Telephone Number: *
Your answer
Parent/caregiver's Cellphone: *
Your answer
Home Email Address: *
Your answer
Home Church: *
Your answer
Allergies/Other Medical Conditions: *
please indicate N/A if none exist.
Your answer
In Case of Emergency Contact: *
Your answer
Emergency Contact Phone: *
Your answer
Relationship to Child: *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms