SOUTHTOWN SUMMER CAMP 2019

July 15-19 | SUMMER CAMP is happening at Southtown Baptist! Get exited for YOU CHOOSE: The Ultimate Game of Would You Rather

Child Information

Name

*

Parent Information

Parent/Guardian Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Age Information (Children age 4-going into 6th grade)

Birthdate

*

Last Grade Completed in School

*

Please select one option.

PK K 1st 2nd 3rd 4th 5th

Medical Information

Allergies?

Please list any other medical or information we need to know (disabilities, behavioral issues, etc.)

Emergency Contact (other than parent/guardian listed above)

Emergency Contact Name

*

Emergency Contact Phone Number

*

Dismissal Information

Please enter full names of each adult, separated by a comma, that is authorized to pick up the child.

Adults authorized to pick up child

Other Information

Does your child attend Sunday school?

Please select all that apply.

Yes No

If so, where?

May we have permission to photograph your child?

*

Please select all that apply.

Yes No

If we can photograph your child, may we have permission to use your child's photograph for the purpose of promotion or on our church social media?

*

Please select all that apply.

Yes No

How did you hear about Summer Camp?

*

Please select one option.

Southtown Baptist Church Online/Social Media Local Outdoor Advertising Friend Other

Would you like to receive information about Southtown's Children's Ministry?

*

Please select all that apply.

Yes No

Description

July 15-19

SUMMER CAMP is happening at Southtown Baptist! Get exited for YOU CHOOSE: The Ultimate Game of Would You Rather

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