Kids bible Camp

Preschool Squire Registration Form

Child First Name

Child Last Name

Birthdate

Age

3 Years (on or by April 1, 2024)

4 Years

5 Years - Young 5 or Kindergarten by this Fall

5 Years - NOT in Young 5 or Kindergarten by this Fall

Gender

Boy

Girl

Special Needs / Allergies

Anything else we need to know about this child?

Parent(s)/Guardian - First and Last Name(s)

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Email

Phone Number

Emergency Contact - First and Last Name

Emergency Contact - Phone Number

During drop-off, please let us know if someone else is picking up this child. They will need to present their driver's license.

Person responsible for pick-up after Kids Bible Camp

Pick-up Person's Phone Number

Relationship to child

Any questions or comments?