Kamp Kaboom Online Registration Form

July 24 & 25, 2008
10 AM - 2 PM

Free science camp for 1st - 5th graders

**Space is limited--spot is not guaranteed until confirmation is received from the church office.

NOTE: ONLY 5TH GRADE
REGISTRATIONS ARE BEING ACCEPTED


Please enter only one child per form.

Registration for:

Child Name:      

Gender:  

Parent Name:

Street Address: 

City:   

State:              ZIP Code:

Home Phone:

Work Phone: 

Mobile Phone:

E-Mail Address:

Grade Completed:

Date of Birth: (MM-DD-YY)

Emergency Contact Name & Phone Number (other than parent):

Serious Allergies:

Who has permission to pick up child (other than parent listed above):

Release for Media Purposes:

 

        

 

 

 

 


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3115 Ocean Drive, Corpus Christi, Texas 78404         Phone: 361-888-8228;  Fax: 361-888-5905
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