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Children's Summer Camp 2021 on Monday, June 28, 2021 @ 8:00 AM

>>> NOTE:  Attendee’s name and information above refers to your CHILD'S information.  Also, please make sure you have selected the correct PRICE.  There is a DROP-DOWN that allows you to change the price to the $100 DEPOSIT!!!!
Estimated T-Shirt size as of June 2021
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Tower of Faith (Climbing Wall/Zip Line): Your child must be over 65 lbs to participate. You will be required to sign a release form at the Mandatory Parent/Camper meeting.
   
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This form cannot be saved and accessed later. Please be aware that further down, we will be requesting roommate information for your child. You will need to know the name(s) of the roommates being requested to complete this form.  We do our best to honor these requests.
*Child's Gender:
*Grade Completed as of June 2020:
*Child's Date of Birth:
*Parent(s) Name:
*Parent(s) Cell Phone Number:
*Parent Email address where you want all camp correspondence to go:
*Secondary Emergency Name:
*Secondary Emergency Phone Number:
*Name of person making deposit/payment :
*The Payer's relation to the child:
My child would like to room with (must be the same grade):
1st Choice:
2nd Choice:
Name of Church attending (if any):
Any additional information that we will need to know please enter here (like allergies):
My child has permission to attend Children’s Camp with Bell Shoals Baptist Church and participate in all the activities at Camp Kulaqua. I understand that I am responsible to provide a NOTARIZED medical release form and to complete the mandatory virtual parent/camper meeting that will become available in early June.:
*Consent:
*Are you making a Deposit or Paying in Full:
**** ATTENTION: If you wanted to pay the DEPOSIT ONLY and the Registration Total below does not reflect the $100 deposit amount, please DO NOT select 'Next'. Go to the top of this form and change the price by selecting the DROP-DOWN option :

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