2017 Kids Camp Registration

July 30th - August 2nd, 2017.

Cost is $175 per child.

Camper's Information:

Camper's Name

Age

Date of Birth

Current Grade

Address/City/State/Zip (Example: 7807 E. 76th Street, Tulsa, OK, 74133)

Camper's T-Shirt Size? (Youth Sizes)

Parent/Guardian Information:

Parent/Guardian Name

Parent/Guardian Email Address

Parent/Guardian Phone Number

Insurnace Provider Information:

Insurance Provider Name

Insurance Provider Policy Number

Primary Care Physician Name and Phone Number

Medical Questions:

May your child be given over-the-counter, non-prescription medications or applicants, not to exceed recommended dosage, for stomch discomfort, burns, cuts, insect bites, headaches, scrapes, or other minor ailments?

Yes

List Exceptions

Questions or special concerns (Allergies, Medications, Medical Conditions, etc)?

***Please note that by registering online, a signature from the child's parent/guardian will be required before the child can participate.

Please remember to complete your child's registration by going to Christianchapel.com/Give and paying $175 per child. Thank you!

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