March Break Camp 2023 ONLINE Registration

Please complete one form per child

* Indicates required field

Child's Name *

First

Last

Full address *

Birthdate *

Current Grade in School *

Preferred Pronoun (He, She, They) *

Name *

First

Last

Parent(s) Home Phone Number *

Parent(s) Cell/Work Phone Number *

Email *

Name *

First

Last

Emergency Contact Home Phone Number *

Emergency Contact Cell/Work Phone Number *

Child's Name *

First

Last

Health Card Number with Version Code (optional) *

Allergies (food or other) *

Physical or Mobility Concerns *

Is the camper required to take medication while at camp? *

YES NO

If YES, what medication is required? *

Other health information we should be aware of: *

I give my permission for photographs of my child to be taken for: Facebook, Websites, Promotional use for the Community *

Yes No

Would you like to be added to our email list to get more information from First United Church? *

Submit