2013 Upward Registration Form

2013 Upward Camp Registration

(fill in every field)

Child's Name:

Parent/Guardian Name:

Address:

Phone Numbers:

Home:

Work:

Cell:

Email Address:

Birthday:

Last Grade Completed:

Medical Information

Medical Info./Conditions (include allergies, etc.)

Emergency Contacts (if different than above)

Name:

Phone:

Relationship to child:

Dismissal Information:

List Names of those approved to pick up your child (other than the above):

Person 1:

Person 2:

Person 3:

Church your family attends:

If invited to attend by

someone at CBC, who:

Child's T-Shirt Size:

Youth X Small

Youth Small

Youth Medium

Youth Large

Adult Medium

Adult Large

Adult X Large

Note: Camp Fee is $30 per participant

Payment Options: (choose one)
I will bring my payment by the church office

I will mail in my payment to the church

mail to: Cumming Baptist Church

115 Church Street

Cumming, GA 30040

I will pay the camp fee using the online option

click here

to pay online

We will be taking pictures & video throughout the week. May we use your child's photo?

Yes
No

Comments:

Note: You will receive confirmation of your registration once we receive your form and your payment.