Registration Form: Spring Break Camp 2020
Seaside with Jesus: March 23-27, 2020
Email address *
Child's Name *
Your answer
Child's Age *
Child's date of birth: *
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Name of Parent: *
Your answer
Parent's Primary Phone number: *
Your answer
Parent's cell phone number:
Your answer
Home Address: *
Your answer
City: *
Your answer
Postal Code: *
Your answer
Does your child have any allergies or other medical conditions? *
If yes, please detail here:
Your answer
Please provide us with any information about your child that will assist us in creating their best camp experience:
Your answer
In case of emergency, please provide us with the name of a person we can contact: *
Your answer
Phone number: *
Your answer
Relationship to child: *
Your answer
Child's Family Doctor: *
Your answer
Family Doctor Phone Number: *
Your answer
How will you be sending the $75 fee? (Fee is per child. Please make all cheques payable to Burnaby North Baptist Church.) *
Do you have other children participating in the camp? If yes, please provide their names here. (A registration form and fee must be received for each child.)
Your answer
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