Lighthouse Bible Church

Where the Holy Bible is Wholly Taught


REGISTRATION CARD

Lighthouse Day Camp 2016

July 11-15



     Name:

​_____________________________________________________________________


    Complete Address: __________________________________________________________________________________________________________________________________________________________________________________________________________________


     Home Phone: ___________________________________

     Work Phone: ___________________________________


    Parent/Guardian:

_____________________________________________________________________


     Allergies/Medical Information (What type of reaction? What type of              medication?What time of day? What happens if not taken?) 

 _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


    Birth Date (M/D/Y) ________________________________________________

    Age: __________________________________

    Grade Completed: ______________________

    Brought By: _______________________________________________________

     Church: ___________________________________________________________


  Do you give permission to post your child's picture on our website?  

                                                           Yes      No

   Who will be picking up your child? _____________________________________________________________________