Old Orchard Church

JOIN THE WAITLIST! Our registration is closed, but you can put your child on the waiting list in case a spot opens.

Name of Child

First Name

Last Name

Name of Parent

First Name

Last Name

Phone

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Child's Date of Birth

YYYY

Child's Grade

Do you currently attend a church?

(if yes) Name of Church

Allergies (if any)

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

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Permission to participate

By checking this box, I give my permission for my child to participate in all activities during the week of the OOC Summer Children's Program at Old Orchard Church, PCA.

Old Orchard Church

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