Camp Agape 2017 Children's Camp
Event Timing: June 26th-30th, 2016
Monday-Friday 9:00 AM - 2:30 PM
Kindergarten through 5th Grade

Please complete all items and submit this form. Camp admission is $50, which needs to be turned in to the Polk County Baptist Association or P.O. Box 289, Benton, TN 37307 as soon as possible [or you can turn in your money when you drop off your child on the 26th].

General Information
Child's Name (First and Last)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Child's Age
Child's Gender
School Grade Completed in May 2016
Parent/Guardian Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Mailing Address
Your answer
Street Address
Optional if same as Mailing Address
Your answer
Name of Siblings Attending Camp
List the names of any siblings that will be at camp this year (separated by commas)
Your answer
Child's T-Shirt Size
Church Child Attends
Your answer
Child's Swimming Level
Sinks like a rock...
Swims like a fish...
All Children 8 and under will be provided a mandatory life vest to wear.

For additional information call - Camp Office 338-4153 or Polk County Baptist Center 338-2749

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