CPAC Summer Camp 2018 Registration
Camp activities take place Monday - Friday from 9 AM - 4 PM. Before and After Care is available upon request.
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Gender *
Child's Birthday *
MM
/
DD
/
YYYY
Child's Age *
Your answer
PARENT CONTACT INFORMATION
Please provide the name and contact information of the parent who will be taking primary responsibility for your child's involvement in CPAC. They will be contacted regarding camp activities.
Parent's Full Name *
Your answer
Mailing Address *
Your answer
City, State, and Zip Code *
Your answer
Primary Email Address *
Your answer
Primary Phone Number *
Your answer
EMERGENCY CONTACT INFORMATION
For major or minor emergencies concerning your child, we will first contact the parent listed above. In the case that they cannot be reached, please provide the name and phone number of an emergency contact below.
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Please list the names of those who are allowed to pick-up your child from camp. (You may add people to this list as needed.) *
Your answer
Is there anything else we should know about your child? (For example: food allergies, physical/mental disabilities, behavioral concerns, etc.)
Your answer
Please check all the weeks of camp your child will be attending: *
Required
How did you hear about CPAC? *
Next
Never submit passwords through Google Forms.
This form was created inside of Christian Performing Arts Center. Report Abuse - Terms of Service - Additional Terms