Camp BIG Splash Registration 2022
Please fill out one form per child.
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Camper's Full Name: *
Address: *
Parent/Guardian One Full Name: *
Parent/Guardian One Phone Number: *
Parent/Guardian Email: *
Parent/Guardian Two Full Name:
Parent/Guardian Two Phone Number:
Child's Date of Birth: *
Child's Grade in School Fall 2022: *
Child" *
Choose one:
Child will attend: *
My child is Immersed? *
Choose one:
Does child have any special needs? (Yes or No) If yes, will your child need a one on one buddy?  Please reach out to Michelle Maris if you need details.                 *
Please list allergies and/or other health concerns: *
Emergency Contact Person Name, Relationship to Child and Phone Number: *
Health Insurance Provider, City and Phone Number: *
Family Doctor Name, Location and Phone Number: *
Family Dentist, Location and Phone Number:
T-shirt Child Size: *
I give permission to Atlanta Christian Church to take pictures, video and/or post on sociaal media images of my child: *
Parent/Guardian Signature: *
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