Camp Registration – EastRidge Church

Number of children I am registering

Parent/Guardian Name

Parent home phone number

Relationship to camper

Parent Email

Parent cell phone number

Address

Child One Name and Date of Birth

Week 1 – July 11-15 – Week is full – No longer receiving registrations

Week 2 – July 18-22 – Week is full – No longer receiving registrations

Week 3 – August 8-12 – Week is full – No longer receiving registrations

Week 4 – Program Full – No longer receiving registrations

Week 5 – August 22-26 – Jr. High (Gr6-8)

Full Day Program Only – 10a-4p – $50

Week 4 – Program Full – No longer receiving registrations

Emergency contact Name and Phone number

Doctors Name and Phone number

Approved Alternate Pick-up Person(s)

I approve the following person to pick up my child/ren