Christ Presbyterian Church

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

You’re Invited to Christ's Kids Club 2022!

We are excited to have you join us for games, crafts, music, and more on August 1-4 at 4-6:30p!

The cost for the week is $40 per child.

Cost includes dinner for each night and other materials for the week.

Financial aid is available if the registration cost keeps you from joining us.

Please email matt.korman@cpcfairfield.org if you have questions.

Camper Registration

Qty

Description

Amount

Total

Registration

$40.00

---

per child

Total: $0.00

Camper Information

Camper #1 First Name: *

Last Name: *

Age: *

Allergies: *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Additional Information:

If there is specific information you would like us to know about this camper, please enter here

Release Information

If my child requires immediate emergency treatment, either because of illness or accident, I hereby authorize Christ Presbyterian Church to call in a physician or take my child to a hospital or physician's office for this purpose.

Medical Treatment Release: *

I give permission for my child to be photographed and/or filmed for camp purposes.

Photo Release: *

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *