Register below: Please contact us at southsalemchurch@gmail.com if you would prefer a paper copy.

Attendee #1 *

First Name

Last Name

Attendee #2

First Name

Last Name

Attendee #3

First Name

Last Name

Attendee #4

First Name

Last Name

Attendee #5

First Name

Last Name

Address *

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Phone Number *

(###)

###

####

Photography

Photographs (stills only): Photographs are for classroom use only and will be sent home at the end of the week. Photos will not be posted on any social media platforms.

Medical Treatment *

Medically treated by first-aid-trained staff in case of emergency of if the parent or alternate contact cannot be reached. If deemed necessary by staff, 9-1-1 may be contacted prior to parent or alternate contact notified.