Camp Grove PAC
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Parent/Guardian Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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Child 1 Name and grade
*
Child 2 Name and grade
Child 3 Name and grade
Child 4 Name and grade
Child 5 Name and grade
Additional family members who will be joining us for Dinner Church at 6:00 p.m. Please list names and any food allergies/sensitivities
*
Please list any information about camper's medical, allergies, and behaviors here. State name and details for each entry.
*
I understand that transportation is not provided and I will need to bring my child(ren) to and from the church.
*
Please select all that apply.
Yes
I release Prairie Grove First United Methodist Church and all its entities and individuals from liability.
*
Please select all that apply.
Yes
Donations appreciated
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
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FM
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GU
HI
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ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
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WA
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Submit
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