MERCY KIDS SUMMER CAMP REGISTRATION

GO TO CAMP WITHOUT LEAVING TOWN

WHEN : June 20-23
WHERE : Mercy Crossing
1978 Joseph Martin Hwy
TIME : 6:30pm - 8:30pm

Child's Name

First Name

Last Name

Child's Age

Gender

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####