Camper Registration Form

Bilberry Creek Baptist Church
Camper Registration Form

Fill out the form carefully for registration
Camper's Name *

First Name Middle Name Last Name
Gender

Boy Girl
School Grade in September *
Birth Date

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian E-mail *
example@example.com
Phone Number *
Alternate Number
Work Number
Emergency Contact Name *
Emergency Phone Number *
Please enter a valid phone number.
Name of People authorized to pickup and/or drop off my child. (Add arrangement details as necessary) *
Church Currently attending
Siblings attending Camp - name, age, grade in September
My child would like to be in a group with (a child of similar age).
Does your child have any allergies or other health concerns *
Health Card Number
Participation Fee of $20

May be paid in person by cash or cheque payable to Bilberry Creek Baptist Church
Email
example@example.com
Signature

Clear
For further information, please contact
Should be Empty:

Bilberry Creek Baptist Church