Musical Day Camp Sign Up

Please complete this form to register your child for Musical Day Camp at Buffalo Valley Church of the Brethren. All fields are required.

August 9-13, 2010 (Monday-Friday)
9:00 AM to 1:00 PM

Musical Day Camp Fees:
$20.00 for the first child in a family.
$10.00 for each additional child in the same family.

Register Early!
This camp has a limited number of slots and fills up quickly.

	Musical Day Camp Registration
First Child from the same family ($20):
First Child's Name:
Age:	Sex: Male Female
Grade Completed:	DOB:
Additional Children from the same family ($10 per child):
Child 2 Name:
Age:	Sex: Male Female
Grade Completed:	DOB:
Child 3 Name:
Age:	Sex: Male Female
Grade Completed:	DOB:
Child 4 Name:
Age:	Sex: Male Female
Grade Completed:	DOB:
Child 5 Name:
Age:	Sex: Male Female
Grade Completed:	DOB:
Medical, Allergic or Dietary Restrictions
Does your child have any medical conditions, allergies or dietary restrictions that we should be aware of? Yes No
If YES, please explain:
Parent/Guardian Information:
Parent/Guardian:
Address 1:
Address 2:
City:
State:	Zip:
Phone:
Email:
Comments/Questions:
Please mail your check made payable to "BVCOB" and note your child's name on the check. Buffalo Valley Church of the Brethren ATTN: Childrens Ministry Team 46 Brethren Church Road Mifflinburg, PA 17844