Child's Name *
Child's Name
Birthdate *
Parent/Guardian Name *
Parent/Guardian Name
Address *
Home Phone *
Home Phone
Cell Phone/Mother
Cell Phone/Mother
Cell Phone/Father
Cell Phone/Father
At dismissal my child will
Emergency Contact *
Emergency Contact
To be notified if parents cannot be reached.
Emergency Contact Phone *
Emergency Contact Phone
Enrollment Consent
I give permission for my child to be treated in the event of an emergency and authorize the leadership of First Baptist Wheaton to act in my behalf in this matter. I consent for my child to participate in various Christian activities, including Bible stories, songs, and prayer. I consent for my child to go on walking trips to Northside Park and Hawthorne School Library. Please note that a separate permission slip will be sent home for any field trips that require transportation. I consent to have my child's photograph taken while he/she is participating in activities at school or on field trips. These pictures are taken to be used in school activities or shown at school functions. They will not be given out to other groups. (For website permission, see below.) I give consent to enroll my child in Breakthrough Summer Camp (June 26 - July 28, Monday - Friday 9:00am - 1:00pm; no school July 3, 4).
Release to use Photographic Images on Web or Print Publications
The undersigned consents to have photographs taken of my child during camp used on the First Baptist Wheaton Website and/or in Breakthrough Summer Camp promotional material. No names will be used.

Breakthrough is a five-week summer camp designed to engage young minds, strengthen academic skills and form cross-cultural friendships. Exciting weekly themes will be explored through a variety of activities designed to improve competency in reading, writing and STEM (science, technology, engineering, math). Our classes are culturally diverse on purpose to increase awareness and understanding of cultures that are different from our own. Each grade level is taught by an experienced teacher who works alongside other classroom staff to help each student succeed, providing opportunities to develop decision-making skills, cooperate with others, choose positive behavior, and learn other life lessons. On Friday, kids will enjoy a VBS program led by FBW's student ministry filled with all the things kids love, games, crafts, stories and music. VBS is open to all kids Kindergarten through grade 5, not just those attending camp Monday—Thursday.  

Breakthrough Summer Camp Registration

Please fill out the form below for each child participating. After submitting this form, please follow the link below for payment.