Mt Olive Baptist Church Crossett AR
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It All Happened In The Country 2017
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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
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Submit
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