Breakthrough Summer Camp Registration 2018

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

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
Weeks enrolling *
Check all weeks you plan to attend. Registration Fee: $40 (1 week), $80 (2 weeks), $110 (3 weeks), $140 (4 weeks)
At dismissal my child will *
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 (July 9 - August 2, Monday - Wednesday 9:00am - 1:00pm; Thursday 9:00am - 3:00pm; no camp Fridays).
T-shirt Size *
Emergency Contact *
Emergency Contact
To be notified if parents cannot be reached.
Emergency Contact Phone *
Emergency Contact Phone
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.