RegistrationTest | Christadelphian Kids Camp California

Children 9 or over who will attend

How many children 9 or over would you like to register? *

Registrant 1

Registrant 1's Name *

First

Last

Registrant 1's Gender *

Registrant 1's Birthdate *

Registrant 1's Phone *

Registrant 1's Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Registrant 1's Email *

Choice of Afternoon Activities (filled on a first come, first served basis, as needed)

Registrant 1's First Choice *

Registrant 1's Second Choice *

Registrant 1's Third Choice *

Registrant 1's T-Shirt Size *

Registrant 1 plays the piano and would be willing to play a couple hymns *

Registrant 2

Registrant 2's Name *

First

Last

Registrant 2's Gender *

Registrant 2's Birthdate *

Registrant 2's Phone *

Registrant 2's Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Registrant 2's Email *

Choice of Afternoon Activities (filled on a first come, first served basis, as needed)

Registrant 2's First Choice *

Registrant 2's Second Choice *

Registrant 2's Third Choice *

Registrant 2's T-Shirt Size *

Registrant 2 plays the piano and would be willing to play a couple hymns *

Registrant 3

Registrant 3's Name *

First

Last

Registrant 3's Gender *

Registrant 3's Birthdate *

Registrant 3's Phone *

Registrant 3's Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Registrant 3's Email *

Choice of Afternoon Activities (filled on a first come, first served basis, as needed)

Registrant 3's First Choice *

Registrant 3's Second Choice *

Registrant 3's Third Choice *

Registrant 3's T-Shirt Size *

Registrant 3 plays the piano and would be willing to play a couple hymns *

Registrant 4

Registrant 4's Name *

First

Last

Registrant 4's Gender *

Registrant 4's Birthdate *

Registrant 4's Phone *

Registrant 4's Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Registrant 4's Email *

Choice of Afternoon Activities (filled on a first come, first served basis, as needed)

Registrant 4's First Choice *

Registrant 4's Second Choice *

Registrant 4's Third Choice *

Registrant 4's T-Shirt Size *

Registrant 4 plays the piano and would be willing to play a couple hymns *

Special Needs or Requests (Dietary or Medical Needs, Campmate requests, etc.)

Parent/Guardian 1 Information:

Parent/Guardian 2 Information:

Interested in Counseling?

Child 1

Child 2

Child 3

Child 4

Children 9 or over who will attend

Registrant 1

Registrant 2

Registrant 3

Registrant 4

Permission for Medical Care

Please provide names and phone numbers of two people to contact in case of emergency

Payment Information