Centrikid Camp Registration - Hope Point Church

Parent's First Name

Last Name

Phone Number

Spouse's First Name

Spouse's Email

Spouse's Phone Number

Student's Information

Student's Name

Student's Grade

Birth Date

Please list Allergies, Special Needs or Medical Information we need to know

0 /

Do you want to register another child?

YesNo

2nd Student's Name

2nd Student's Grade

Birth Date

Please list Allergies, Special Needs or Medical Information we need to know

0 /

Do you want to register any other children?

YesNo

3rd Student's Name

3rd Student's Grade

Birth Date

Please list Allergies, Special Needs or Medical Information we need to know

0 /

Comments

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Please upload a copy of the front and back of your insurance card. (You can take a picture with your phone)

Upload Front of Insurance Card

Upload Back of Insurance Card