New Life Church Milton

Camp Week Requested (please check appropriate box):

$175 Adventure Camp - July 17 - 21

$175 Countries and Cultures Camp - August 14 - 18

Camp T- Shirt size: required

Must be worn daily - included in the registration fee.

Child's Information required

FirstLast

Grade

Age

Date of Birth required

MMDDYYYY

Address

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Name(s) and Age(s) of Siblings

Child lives with required

Is extended care required? An additional fee of $70 will be charged by our licensed partner provider, Firm Foundation.

details:

Emergency Information:

Parent/ Guardian's Name required

FirstLast

Email Address

Cell Phone Number required

(###)#######

Work Address required

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Work Phone Number

(###)#######

Parent/ Guardian's Name required

FirstLast

Email Address

Cell Phone Number required

(###)#######

Work Address required

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Work Phone Number

(###)#######

Please list two people who are permitted to pick up your child and/or who may be contacted in the event of an emergency:

Name

FirstLast

Relationship required

Phone Number required

(###)#######

Name

FirstLast

Relationship required

Email Address

Phone Number required

(###)#######

What we need to know about your child:

Allergies: required

yes

no

If yes, is an Epi-pen or Benadryl required in the event of an allergic reaction?
*Please request additional anaphylaxis & minor allergies forms.

Describe:

Special Diet

Medical Condition

Rest Requirement

Exercise Restriction

Thank you for completing this registration form. A spot will be confirmed for your child upon receipt of payment. Please attend the church office with your payment by cash, check or credit card.

Other

Summer Camp Registration Form