2013 Summer Camp Registration Form

VBS Registration 2013
Child 1: Name

First NameLast Name
Entering Grades K thru 8 (Choose 0 for K)
Gender
Allergies/Medical Problems
Any friends that they would like to be with.
Child 2: Name

First NameLast Name
Entering Grades K thru 8 (Choose 0 for K)
Gender
Allergies/Medical Problems
Any Friends that they would like to be with.
Child 3: Name

First NameLast Name
Entering Grades K thru 8 (Choose 0 for K)
Gender
Allergies/Medical Problems
Any friends that they would like to be with
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Best # parent can be reached in case of emergency:

Area CodePhone Number
Alternate Contact Person

First NameLast Name
Alternate Contacts #

Area CodePhone Number
I,__________ have allowed the above mentioned child/children to attend Kids Camp/VBS from July 8- July 12 from 2-5 pm.

First NameLast Name
How did you hear about Kid's Camp!
Interested in Volunteering (Nursery & PreK care available for volunteers)
I give permission for my child/children to be photographed
Donation..
The suggested donation is $25 per child, which can be conveniently
paid below using a credit or debit card. ***If you are unable to make a donation at this time you must mark 0.

You may also mail payment to:
Hope Church, 240 Wolpit Road, Wilton, CT 06897,
or bring your donation on the first day of Camp...

Thank you!

USDHope Church VBS 2013

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

VBS Registration 2013