Christmas Camp Registration 

Child's Name (required)

Parent/Guardian (required)

Address (required)

City (required)

Zip (required)

Phone Number (required)

Your Email (required)

Child's Date of Birth (required)

Child's Grade this Fall (required)

Other Adults Authorized to pick up your child

Emergency Contact and Phone Number (required)

Allergies/Special Needs (if any)

Any additional information you would like to provide