Camper Name *

First Name

Last Name

Child's Birthday Date *

MM

DD

YYYY

Parent 1 Name *

First Name

Last Name

Parent 1 Phone Number *

(###)

###

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Parent 2 Name

First Name

Last Name

Parent 2 Phone Number

(###)

###

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Photo Permission ? *

Please check the box if you give permission for your child's photograph to be used for summer camp recap. It may show up on our social media pages to highlight Kids' Ministry.

Yes, my child's photo can be taken.

No, my child's photo cannot be taken.