2019 Messiah Summer Day Camp Registration
Thank you for registering for Messiah Summer Day Camp. Each family must complete one registration online form. The form will take about 10 minutes to complete and the following information will be required to submit. There is no option to save and return to the registration later.

-Parent Contact Information
-Three Emergency Contact's Information (Other than parents or guardians)
-Doctor Contact Information, Hospital Preferences, Insurance Information.
-Online Payment upon completion of registration.

If any required fields do not apply, simply state "N/A".

Once the form is submitted, you will receive a link to an online store. Please pay your registration fee immediately or save the link to pay within 7 days. If the payment is not received within 7 days, your registration will be cancelled. You will be notified of cancelled registrations via email. All registration fees are nonrefundable.

Please contact wpinkston@messiahnetwork.org for any questions or concerns.

Email address *
Secondary Parent Email *
Your answer
Family Address *
Your answer
Family City *
Your answer
Family Zip Code *
Your answer
Family Church Home *
Your answer
Mother's Full Name *
Your answer
Mother's Phone Number *
Your answer
Does mother have permission to pick up the child or children? *
Father's Full Name *
Your answer
Father's Phone Number *
Your answer
Father's Secondary Phone Number *
Your answer
Does father have permission to pick up? *
Are there any special pick up instructions, home life information, or custody situations that camp staff needs to be aware of? Please share below. *
Your answer
First Emergency Contact other than Parents (Name, Relation, and Phone Number) *
Your answer
Does the First Emergency Contact listed above have permission to pick up? *
Second Emergency Contact other than Parents (Name, Relation, and Phone Number) *
Your answer
Does the Second Emergency Contact listed above have permission to pick up? *
Third Emergency Contact other than Parents (Name, Relation, and Phone Number) *
Your answer
Does the First Emergency Contact listed above have permission to pick up? *
Primary Physician Name and Address for Children *
Your answer
Primary Physician Phone Number *
Your answer
Preferred Hospital in Case of Emergency *
Your answer
Insurance Policy Name, Group Number, and I.D. Number *
Your answer
How often do you plan on using camp this summer? (This is just for planning purposes. No commitment is needed at this time.) *
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