Summer Day Camp Registration Form Parent NameParent NameChild 1: NameChild 1: Birth Date (including year) Date Format: MM slash DD slash YYYY Child 1: Grade for 2019-2020 School Year Age 3 Age 4 Age 5 (has not been in kindergarten) Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Child 1: T-Shirt Size Youth Extra Small (2-4) Youth Small (Size 6-8) Youth Medium (Size 10-12) Youth Large (Size 14-16) Adult Small Adult Medium Adult Large Adult Extra Large Child 1: SchoolChild 2: NameChild 2: Birth Date (including year) Date Format: MM slash DD slash YYYY Child 2 Grade for 2019-2020 School Year Age 3 Age 4 Age 5 (has not been in kindergarten) Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Child 2: SchoolChild 3: NameChild 3: Birth Date (including year) Date Format: MM slash DD slash YYYY Child 3 Grade for 2019-2020 School Year Age 3 Age 4 Age 5 (has not been in kindergarten) Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Child 3: SchoolMailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Email Other Email Primary PhoneOther PhoneChurch HomeAllergies or Special Needs/ConcernsAnything else you'd lIke to share?For More InformationContact Rev. Anita Thompson, Associate Pastor for Music & Worship, at anita@fbcahoskie.org, or 252-395-0061.
