Love, Joy, Peace...
Delburne Gospel Church
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Name
(
Required
)
Email Address
(
Required
)
Child's Name (
Required
)
Birthday (
Required
)
Age (
Required
)
How old is this child who is attending?
4
5
6
7
8
9
10
11
Parents Contact Number (
Required
)
Best number during the day to get ahold of you
Allergies or Special Notes
Emergency Contact (
Required
)
Who can we contact if you are not available?
May we photograph (
Required
)
We would like to photograph the kids in this Adventure Camp
Yes
No
T-shirt size (
Required
)
Youth - Sm
Youth - Med
Youth - Lg
Adult - Sm
Adult - Med
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