Sign Up here COW CAMP 2022 Child #1 Name Name of Child #1 Child #1 Grade Last grade completed Child #1 Birthdate Birthdate of Child #1 Child #2 Name Name of Child #2 Child #2 Grade Last grade completed Child #2 Birthdate Birthdate of Child #2 Parent(s) Name(s) Name(s) of Parent(s) Home Address Home Phone # Home Phone # Alternative phone number EMERGENCY Contact Name Name of person to contact in case of EMERGENCY EMERGENCY Contact Number Phone number of EMERGENCY contact EMERGENCY Contact Relationship Relationship of EMERGENCY contact to child Food Allergies? * Yes No If YES to FOOD ALLERGIES, please explain Siblings Attending Names and ages of siblings attending Do you attend PCCC? Yes No Church Affiliation Name If not a PCCC member, which church do you attend? Name/s and phone number/s of Person/s who may pick up child Names and numbers of people who may pick up child PHOTOGRAPHY- I understand that photography/video may be used by PCCC Staff for social media, website & Church announcement boards. YES, I understand. Digital Signature of Parent/Guardian * This checked box signifies my digital signature Phone number of person who signs digitally * reCAPTCHA If you are human, leave this field blank. Δ
