Father/Child DAY Camp 2020 Registration
*June 6th from 9am-9pm
*Cost: $10 per family
*Please make checks payable to Delphi UMC and mail to:

Delphi UMC
1796 N US Hwy 421
Delphi, IN 46923

*For planning purposes PLEASE let us know if your plans change and you aren't able to attend.
*We'll have activities at DUMC as well as Prophetstown State Park.
*You'll receive a letter in the mail 2 weeks prior to the event with all the details you need!
*Please register by 4/26

Email address *
*I realize that I will be responsible for my child(ren) during this camp. I will be responsible for any regular medications that my child needs. Also, I understand that pictures/video will be taken of my child for promotional purposes by Delphi UMC. Electronic Signature: *
Your answer
Father's Name: *
Your answer
Address, City, Zip: *
Your answer
Phone #: *
Your answer
Child #1: *
Your answer
Address (if different than father):
Your answer
Gender *
Date of Birth: *
MM
/
DD
/
YYYY
Grade in Fall 2020: *
Your answer
Allergies: *
Your answer
Any other medical information we should know?
Your answer
Alternate Emergency Contact with phone #: *
Your answer
Child #2:
Your answer
Address: (if different than father)
Your answer
Gender:
Date of Birth:
MM
/
DD
/
YYYY
Grade in Fall 2020:
Your answer
Allergies:
Your answer
Any other medical information we should know?
Your answer
Alternate Emergency Contact with Phone #: (if different than Child #1)
Your answer
Child #3:
Your answer
Address: (if different than father)
Your answer
Gender
Date of birth:
MM
/
DD
/
YYYY
Grade in fall of 2020:
Your answer
Allergies:
Your answer
Any other medical information we should know?
Your answer
Alternate Emergency Contact: (if different than other children)
Your answer
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