SOUTHTOWN SUMMER CAMP 2021
July 14-18 | SUMMER CAMP is happening at Southtown Baptist!
Wed, Thur, Fri 6-8:30 p.m. & Sat, Sun 10 a.m.-noon
Family Information
Parent/Guardian Name(s)
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child's Name
*
Birthdate
*
Last Grade Completed in School
*
Please select one option.
PK
K
1st
2nd
3rd
4th
5th
Select 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
*
Other Information
Do your children attend a church?
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
Submit
Description
July 14-18
SUMMER CAMP is happening at Southtown Baptist!
Wed, Thur, Fri 6-8:30 p.m. & Sat, Sun 10 a.m.-noon
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