Pulse Presents - Camp Pulse
Camp Pulse is a weekend experience where children will encounter Christ like never before, embrace community, and be energized to take the gospel to their generation.
Email address *
Camp Pulse Registration Fee
There is a $75.00 registration fee due, Sunday July 30. Cash payments are accepted before or after Celebration Service. Online payment can be made on the Harvest Church Ministries by selecting the proper drop-down under "Donate"
Participant Information
Participant Name (Last, First) *
Your answer
Gender *
Date of Birth *
Grade for the 2018/2019 School Year *
Address (City, State, Zip Code) *
Your answer
Phone Number *
Your answer
Emergency Contact Information (Must be a parent or guardian if under 18) *
Your answer
Address (if different from above)
Your answer
If Emergency Contact is unavailable, please provide a secondary contact (Name, relationship, and phone number) *
Your answer
Medical Information
Medical Carrier Name
Your answer
Policy Number
Your answer
Allergies or Medial Issues (please explain) *
Your answer
Special Needs or Physical Accommodations Needed (please explain) *
Your answer
Waivers and Informed Consent
By clicking yes on this form, I, as parent/guardian, permit the Harvest Church Ministries to use pictures of my child(ren) as a program participant in promotional literature, videos, and the HCM website and social media pages. I understand my child(ren)’s name(s) will not be published.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms