PA Day Camp: Waiting for Christmas

Name: PA Day Camp: Waiting for Christmas
Start: 2026-11-20T09:00:00-05:00
End: 2026-11-20T13:00:00-05:00

November 20 @ 9:00 am - 1:00 pm

Registration Form

Comments
This field is for validation purposes and should be left unchanged.
Child Information:
Child's Name*
First Last
Age*
Please enter a number from 3 to 15.
Medical alert?*
Does this child have any food allergies or accessibility issues? Will this child require any medication during the program day?
- Yes (Please give explicit details below)
- No
Medical Details:*
Please give explicit details below
Would you like to register more children?
Sibling Information:
Child's Name*
First Last
Age*
Please enter a number from 3 to 15.
Medical alert?*
Does this child have any food allergies or accessibility issues? Will this child require any medication during the program day?
- Yes (Please give explicit details below)
- No
Medical Details*
Please give explicit details below
Sibling Information:
Child's Name*
First Last
Age*
Please enter a number from 3 to 15.
Medical alert?*
Does this child have any food allergies or accessibility issues? Will this child require any medication during the program day?
- Yes (Please give explicit details below)
- No
Medical Details*
Please give explicit details below

Safety and Emergency contact
What is the best way to reach you if we need to be in touch with you urgently during the course of the program?*
Is there anything else we should know about your child(ren) to make this day safe and successful?
Please provide the full name of an emergency contact, a phone number, and the contact’s relationship to the child(ren).
Emergency Contact*
First Name Last Name
Phone*
Relationship to child(ren)*
Photo Release and Permission
Photo Release*
Photographs will be taken throughout the program. If you do not wish your child’s picture to appear in any church publications or on our websites, please let us know by selecting the appropriate box. Your request will be treated in confidence and every reasonable effort will be made to ensure that your request is honoured.
- Yes, you may use my child’s picture
- No, do not use my child’s picture
Guardian Permission (Name)*
I hereby give permission for my child(ren) to participate in the Children’s Program outlined above
Parent or Guardian Name
Signature*
Your Name
Your Name
Your Name

Details