Mt Olive Baptist Church Crossett AR
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Disciple Kid Weekend 2017 @ Wolf Creek Camp is March 3-5
for 3rd-6th Graders
Cost is $30 which includes meals, t-shirts, materials.
Please complete all information.
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indicates required information.
Contact Regina Hodge @ 870-305-5024 if needed
CHILD INFORMATION
PARENT INFORMATION
*
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Child's Name
*
Address
*
Date of Birth
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School Grade Completed
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Christian?
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Yes
No
Church Member?
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Yes
No
Church Name
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T-Shirt Size (Choose One)
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Youth Small
Youth Medium
Youth Large
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Adult Small
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Parent's Name
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Phone Number
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Address
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Email Address
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Emergency Contact Number
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Relevant Medical/Allergy Information
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