Summer Day Camp Registration Form Parent Name Parent Name Child 1: Name Child 1: Birth Date (including year) 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: School Child 2: Name Child 2: Birth Date (including year) 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: School Child 3: Name Child 3: Birth Date (including year) 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: School Mailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Email Other Email Primary PhoneOther PhoneChurch Home Allergies or Special Needs/Concerns Anything else you'd lIke to share? For More Information Contact Rev. Anita Thompson, Associate Pastor for Music & Worship, at anita@fbcahoskie.org, or 252-395-0061.
