KIDS CAMP REGISTRATION 2023

Child Information

Child's Name

Grade Completed

Age

Child's Name

Grade Completed

Age

Child's Name

Grade Completed

Age

Parent and Contact Information

Parents' names

Home address (Members of St. Matthew may skip this question)

Primary phone

Alternate phone

Contact Email Address

Emergency Contact Information

Emergency contact person

Phone

Relationship to child

Health Information

Food Allergies

List

Medical or other concerns

List

Church Information

Church affiliation

Church membership at

Additional Information

Please list the adults who will be picking up children

Attendance (days)

Kids Camp leaders have permission to photograph/film the minor (s) designated above in any manner or form for any lawful purpose associated with this program.

Verification to update your information with St. Matthew's records.

You must verify before submitting.