Peace Camp Registration, 2019

August 12 - 16, Monday - Friday, 9:00 a.m. to 12:30 p.m.
Rising K-8 Grades

First Mennonite Church
601 East Parham Road
Richmond, VA 23227

 
Contact Information
Child's Name *
Child's Name
Parent/Guardian *
Parent/Guardian
Emergency Contacts
Emergency Contact 1 *
Emergency Contact 1
Emergency Contact 2
Emergency Contact 2
People Allowed to Pick Up Your Child (Other Than Those Listed Above)
Pick-Up Person
Pick-Up Person
This person is not already listed above, but is allowed to pick up your child
Pick-Up Person
Pick-Up Person
This person is not already listed above, but is allowed to pick up your child
Health and Medical Information Insurance
Check all that apply to your child, providing addtional information as needed:
Checkbox
Medical Emergency Waiver
will be signed by parents the first day of Peace Camp.
By typing your name you acknowledge that the above information is correct.