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- Teen Ministry

2019 Vacation Bible Camp Registration 8/5-8/9
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- Child's Last Name REQUIRED Please fill out this field. Please enter valid data.
- Child's First Name REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- Town REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Completed REQUIRED Please fill out this field. Please enter valid data.
- Name of School Child Attends REQUIRED Please fill out this field. Please enter valid data.
- Allergies Please enter valid data.
- Medications Please enter valid data.
- Contact Email Address REQUIRED Please fill out this field. Please enter valid data.
- Contact Cell Phone # REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact # REQUIRED Please fill out this field. Please enter valid data.
- Special Request Please enter valid data.
- How Did You Learn About Our Camp? REQUIRED Please fill out this field.
- I have read the printable Release/Assumption of Risks form (located above) and by checking this box I sign and agree to allow my child to participate in the St. Luke Parish Kingdom Rock Vacation Bible Camp REQUIRED Agree Please fill out this field.
- $25.00 Camp Fee can be paid by:
  Venmo: Parish St. Luke LV or a
  Check mailed to P.O. Box 416, Long Valley, NJ 07853
Submit
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