Summer Camp 2019 Registration:St. Louis County

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LifeBridge Camp Enrollment *

I am a current client with LifeBridge Partnership.

I am a new client with LifeBridge Partnership.

Child's Last Name *

Child's First Name *

Child's Date of Birth *

YYYY

Parent or Guardian's Name *

First Name Last Name

Street Address *

City *

Zip Code *

Home Phone *

Include area code

Cell Phone *

Include area code

Email *

Child's Shirt Size *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult 2XL

Camp Transportation *

I will be providing my own transportation to and from camp (Center St. Louis: 6727 Langley Ave., St. Louis, 63123).

I will be meeting LifeBridge transportation at a centralized meet up point throughout St. Louis County.

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