EHBC Camp Lela Registration Form 2013

Eagle Heights Baptist Church Kids Camp Camper’s Application Form EHBC Kids Camp is for children who have completed grades 3 through 5. All blanks must be filled in for the camper to be properly registered. A parent’s signature needs to be on this form along with phone numbers to reach you at all times. Your child’s registration fee should be sent w ith this form. The camp will be held July 8 – 11, 2013. ALL parents AND campers will need to be at the camp mtg on Sun. July 7 @ 12:15 @ Eagle Heights Baptist Church. Meeting will be held in the Fellowship Center. Name of Camper: _____________________________________________________ Age: __________ (First) (Last) Name the child goes by, if different from above:_____________________________________________ Address: _____ ______ City: ___ _____ School Grade Camper has recently completed ___________ Circle one: Male Female Father’s Name: ____________________________________ Daytime Phone #: ____________________ Place of Work: ____________________________________ Evening Phone #: _____________________ Mother’s Name: ___________________________________ Daytime Phone #: _____________________ Place of Work: ____________________________________ Evening Phone #: _____________________ Father’s Church Membership: ____________________________________________________________ Mother’s Church Membership: ____________________________________________________________ Emergency Contact Information If the parents/guardians cannot be contacted, please list another relative that we may contact in the event of an emergency: Name: _______________________________________ Relationship to camper: ____________________ Phone numbers: _______________________________________________________________________ Physician Name: ____________________________________ Phone #: ___________________________ Has the camper been away from home before? _____________ For how long? ______________________ Has the camper ever had difficulties with authori ty figures or discipli ne at home, school or church? If YES, ple ase ex plain. ____________________________________________________________________ ______ _____ _

EHBC Camp Lela Registration Form 2013

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Transcript of EHBC Camp Lela Registration Form 2013