Lela Registration — Graceway

Name of Camper

First Name

Last Name

Camper Shirt Size

Parent/Guardian Registering This Child

First Name

Last Name

Relationship To Child

Medication Consent

Yes

No

Gender

Age & Last Grade Completed

Child's Birth Date

MM

DD

YYYY

Child's Permanent Residence

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email of Registering Parent

Does Your Child Attend Sunday School Anywhere?

Medical Conditions/Other Information We Need To Know

In case of emergency, please contact:

Emergency Contact Other Than Registrant

First Name

Last Name

Relationship to Child

Contact's Number

(###)

###

####

Electronic Signature Authorization