Calendar | Bethlehem Missionary Baptist Church

Summer Day Camp Signup Form

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Click the button below to download a PDF version of our Summer Day Camp signup form or complete the online form below:

Click here to download a PDF version of the form

Summer Day Camp Form

Child's Name:

First

Middle

Last

Parent(s) Name:

First

Middle

Last

Address:

Home Phone Number:

Cell Number:

Place of Employment:

Work Number:

Church Affiliation:

Select One:

Male

Female

Date of Birth:

MM/DD/YYYY

Date of Enrollment:

MM/DD/YYYY

What is the age of the above child listed?:

Registration Fee:

Registration fee to be paid at church office, fee is $25 per child

Name of last school attended:

School address:

School phone number:

Emergency contact person(s) other than parent:

Name of Physician:

Physician's Phone Number:

Choice of Hospital:

Insurance Company:

This child will be released only into the care of the person(s) name appearing on this application, and or the following person(s):

First

Last

Name

First

Last

By clicking the checkbox you agree to submitting this information to Bethlehem Missionary Baptist Church and verify that the above information is correct

I agree and verify the above information is correct

If you are human, leave this field blank.