DK Weekend 2017

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.
*indicates required information.
Contact Regina Hodge @ 870-305-5024 if needed

CHILD INFORMATION

PARENT INFORMATION

* Indicates required field

Child's Name *

Address *

Date of Birth *

School Grade Completed *

Christian? *

Yes No

Church Member? *

Yes No

Church Name *

T-Shirt Size (Choose One) *

Youth Small Youth Medium Youth Large

*

Adult Small Adult Medium Adult Large

Parent's Name *

Phone Number *

Address *

Email Address *

Emergency Contact Number *

Relevant Medical/Allergy Information *

Submit