Aldersgate Bible Adventure Camp Registration Form

June 10th-14th, 2019 6:00-8:30PM | Please fill out a separate form each child and click submit.

Child's Name

Child's Gender

Please select one option.

Male Female

Address

Cell Phone

This address will receive a confirmation email

Legal Guardians' Names

In Case of Emergency Contact (name and phone number)

Other people authorized to pick up my child.

Allergies or other medical conditions

T-Shirt Size

Please select one option.

Youth X-Small (2-4) Youth Small (6-8) Youth Medium (10-12) Youth Large (14-16) Adult Small Adult Medium Adult Large Adult X-Large Adult 2XLarge

Grade Completed

Please select one option.

PreK (minimum age 5) Kindergarten 1st 2nd 3rd 4th 5th

Birthdate

I give my permission for Aldersgate UMC to seek emergency medical care for my child in the event that I cannot be reached. I release Aldersgate United Methodist Church, its staff and volunteers, or any liability in the event of accident or injury.

Please select one option.

Yes No

Aldersgate UMC uses photography and video for publicity purposes. I give my permission to photograph or film my child for possible inclusion in AUMC publication, website or other publicity materials.

Please select one option.

Yes No

Registration Fee, includes t-shirt, max of $20 per family

Suggested Registration Fee ($10) Requesting Scholarship ($0) Third or additional children ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 10th-14th, 2019 6:00-8:30PM

Please fill out a separate form each child and click submit.

Aldersgate Bible Adventure Camp Registration Form

Description

Please Fix the Following