North Jacksonville Baptist Church

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    Children's Summer Music Camp Registration

    Please complete a form for each child you are registering. We understand this is time consuming, but we want to offer your child the best and safest experience which requires complete registration information. Thank you for your understanding.
    Are you a member of NJBC?
    • Yes
    • No
    Child's Name:
    Parent/Guardian Name:
    Phone Number (Main):
    Phone Number (Alternate):
    Email:
    Last grade completed in school:
    • 1st
    • 2nd
    • 3rd
    • 4th
    • 5th
    • 6th
    T-Shirt Size:
    • Small (Child)
    • Medium (Child)
    • Large (Child)
    • Other
    Medical Information (Special needs, allergies, etc.):
    Primary Emergency Contact Name:
    Primary Emergency Contact Phone Number:
    Alternate Emergency Contact's Name:
    Alternate Emergency Contact Phone Number:
    Please list the names of the individuals who have your permission to pick your child up at the end of Music Camp each day (Only people listed will be allowed to pick children up):
    May we have permission to photograph your child?
    • Yes
    • No