EmailMe Form - Dove UMC Fine Arts Camp Registration

* For children Grade 2 through Grade 7 (completed) *
Child's Name *
First Last
Child's Birthdate *
MM / DD / YYYY
Child's Age *
Grade in School
for 2018-2019 *
Parent / Guardian Name *
First Last
Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Home Phone
### - ### - ####
Cell Phone
### - ### - ####
Email

Re-Type Email
Alternate
Contact's Name *
First Last
Alternate
Contact's Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Alternate Contact's
Home Phone
### - ### - ####
Alternate Contact's
Cell Phone *
### - ### - ####
Allergies or Health Concerns
Special Needs:
I give the church my permission to publish photos of my child on the church website and in local media releases, provided no names are released. *
Yes, I give permission
No, I do not give permission
Name of Person
Giving Permission *
First Last
Date Permission Response
is Provided *
MM / DD / YYYY
EMERGENCY CONTACT DURING CAMP HOURS
Emergency
Contact's Name *
First Last
Emergency Contact's
Phone Number *
### - ### - ####
I will be able to help in the following ways:
Teacher
Teacher Assistant
Kitchen Help
Registration Help
An Extra Pair of Hands
Prayer Support
Other, or specifics for above
By filling in the information below and clicking the 'Register' button, I attest and affirm that the information provided above is true and correct and I wish to register my child for Summer Fine Arts Camp at Dove of the Desert UMC.