St. Timothy VBS Morning Camp June 12-16, 2023 (1st-5th Grade)

Parent Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:
• * Cell Phone:
• Home Church Affiliation
• Secondary/Emergency Contact Name & Cell Number:
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• Alternate Pick-up Name & Cell:
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• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  1st child	$53.00
  2nd, 3rd child etc.	$48.00

Child Information

• * First Name
• * Last Name
• * Gender --Choose-- Male Female
• * Entering Grade (2023-2024) --Choose-- 1st 2nd 3rd 4th 5th
• * Date of Birth
• * T-shirt size --Choose-- Child X-Small (4-6) Child Small (6-8) Child Medium (10-12) Child Large (14-16) Adult Small (34-36) Adult Medium (38-40) Adult Large (42-44) Adult XL (45-48)
• *

  Music choice:

  • CD
  • Digital Download Card
• Does the child have allergies or medical needs we should be aware of?
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• Do you have one friend you would like to be placed with? If so, who? (We will do our best to accommodate but cannot guarantee.)
• Comments:
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Participant Information

You may add a maximum of 4