Kids Camp 2021

Join us for Kids Camp July 25-27, 2021

Child Information

* Last Name * First Name MI
* Last Grade Completed in School * Date of Birth (mm/dd/yyyy)

Parent / Guardian Information

* Last Name * First Name MI
* Address
* City State Zipcode

Contact Information

* Home Phone Cell Phone
* Your Email
Mailing Address (if different from above)
City State Zipcode

Medical Information
* Medical or other information we need to know. (Please include any food allergies.)

Emergency Contacts (Other than listed above.)
* Name: * Phone:
* Name: * Phone:

Dismissal Information
* Who may pick up your child at the end of camp?

Does your child currently attend Sunday School?
YesNo If yes, where?
If your child is visiting our church, who are they a guest of?
* May we have permission to photograph your child?
YesNo
* May we have permission to use your child's photograph for promotion of our programs?
YesNo

Other Notes

Where We Are

Our Street Address:

8801 Perrymont Road
Richmond VA 23237

Phone Number: 804-275-1285
Email Address: info@kingslandbaptist.com

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