Centri Kid Camp

* Indicates required field

Name *

First

Last

Child's Grade *

Parent/Guardian Name *

Cell Phone Number *

Address *

City *

State *

Zip Code *

Parent/Guardian Email *

Child's Food Allergies *

Emergency Contact Name *

Emergency Contact Phone # *

Emergency Contact Relationship to Child *

Other Allergies or Medical Conditions *

May we have permission to photograph and/or video your child for use in church publications? *

Submit

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