Summer Camp Registration

Childs Information

Name

*

Birthday

*

Age

*

Address

*

Phone

*

Email for future correspondence

*

Parents Information

Mother's Name

*

Cell Phone

*

Occupation

*

Employer's Name

*

Work Phone

*

Father's Name

*

Cell Phone

*

Occupation

*

Employer's Name

*

Work Phone

*

How did you hear about City Camp Kids?

*

Facebook Television Roadside sign Friend or relative Other

Payment options

Payments can be paid in person by check, card, or cash or you can mail them in to:

Ekklesia Christian Church
c/o City Camp Kids
2469 E Highway 501
Conway, SC 29526

Make checks payable to Ekklesia in the amount of $100/child for full payment of Summer Camp registration.

Registration must be paid within seven days of completing the online registration form to hold the child's spot for Summer Camp.

Form of payment to be expected

*

Check Credit Card Cash Emailed invoice

Description

Please fill out this form for your child’s Summer Camp registration and click submit. Please submit your payment within seven days to hold your child's spot in Summer Camp.