NAME: __________________________________________ AGE: ___________
CAMP SESSION__________________________________________________
ADDRESS__________________________________________________________________________
EMAIL ADDRESS______________________________________________________________________
CELL PHONE OR OTHER PHONE NUMBER_________________________________________________
PARENT/GUARDIANS' NAME(S) __________________________________________________________
SPECIAL INSTRUCTIONS (SUCH AS FOOD ALLEGIES/DIABILITIES/ETC.)_______________________________________________________________________
TO COMPLETE THIS FORM, INITIAL STATEMENT
BELOW:
____ I UNDERSTAND THAT THE 5.00 DEPOSIT IS NON-REFUNDABLE.
I WILL NOT HOLD RIVER OF GOD WORSHIP CENTER OR THE TEACHERS
RESPONSIBLE FOR ANY INJURY SHOULD IT OCCUR DURING THE COURSE
OF CAMP.