Please fill-out this form in its entirety to register each child for Keeper’s of The Kingdom Summer Day Camp.

Child's Name

First Name

Last Name

Age

School Grade (This Fall)

M/F

Male

Female

Parent Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mom Cell

(###)

###

####

Dad Cell

(###)

###

####

T-Shirt Size

Allergies or Special Needs

Emergency Contact Name

Emergency Contact Phone (mobile)

(###)

###

####

Parent Signature (type full first / last name)

Date

YYYY

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