GV Children's Daycamp
Event Date: June 29, 2019
Event Address: 3110 Cook Road, St. Joseph, MO 64506
Contact us at (816) 279-3621 or godremembersz@gmail.com
SCIENCE: Bible Lab Day Camp
Child's Name *
Your answer
Age of Child *
Grade in School *
Child's Birthdate *
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DD
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YYYY
Parent's Name (or Legal Guardian) *
Your answer
Street Address *
Your answer
City/State/Zip Code *
Your answer
Cell Phone of Parent (or Legal Guardian) (enter with no hyphens) *
Your answer
Email *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone (enter with no hyphens) *
Your answer
Relationship to Child *
Your answer
Please list any Special Needs or Allergies *
Your answer
Please list medications (including dosage) *
Your answer
Contact Name of Person Picking Up the Child *
Your answer
Contact Number of Person Picking Up the Child (enter with no hyphens) *
Your answer
I understand that I will have to pay $20 in additions to this Registration Form (either mailed in or dropped off at GVBC) *
Required
I understand that I will have need to fill out a Medical Release Form BEFORE leaving my child at Children's Day Camp. *
Required
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