Sports Camp Registration Form
June 20-23, 2011
9:00 a.m. - 11:30 a.m.
For all youth entering grades 3-9
Cost is $8/camper - Please make checks payable to FRPC
(includes water bottle, refreshments, and prizes!)

Camper's Name:	*
Grade in fall of 2011:	*
Street address:	*
City:	*
State:	*
ZIP:	*
Parent/Guardian:	*
Home telephone:	*
Email address:
In case of emergency, contact:	*
Relationship to child:	*
Phone:	*
Child may be picked up by:
Please place my child with:
Home church:
Allergies:	Yes   No
If yes, please list:
Medical concerns:	Yes   No
If yes, explain:
(Water bottle availability guaranteed only if you register by June 1st)
Enter text from verification image:
* Indicates requires fields