VBS / Warrior Camp Registration 2024

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Child Information

Child Name

*

Birthdate

*

Grade last completed in school

*

Please select one option.

Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th

School

*

Please select one option.

Clinton Shirley Bee Branch CTC Home school Other

Allergies

*

Please select all that apply.

Gluten Milk Eggs Peanuts Tree nuts Other NONE

Other Allergies? Please explain.

Parents / Guardians Information

Mom's name

*

Dad's name

*

Physical Address

*

Mailing Address if different

Email

*

This address will receive a confirmation email

Mom Cell Phone

*

Dad Cell Phone

*

Mom Work Phone

*

Dad Work Phone

*

Other Emergency Phone Contact #1

*

Other Emergency Phone Contact #2

*

Who may pick up your child?

*

Is there anything else we should know about your child?

*

Please select one option.

Yes No

If you answered yes, please share what we should know about your child.

Administrative Information

May FBC Clinton use your child's photo for promotional purposes?

*

Please select one option.

Yes No

Today's date

*

Description

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