August Gate Church - AG Kids Camp Registration

AG Kids Camp Registration

We're excited for your kids to join us for AG Kids Camp this year!

Important Information
Date: June 24-28
Times: 9:00am-12:15pm
Location:
August Gate Church
1209 Royal Heights Rd.
Belleville, IL 62226

Camp is open to incoming kindergarteners through incoming 5th graders (based on their grade for fall of 2024).

Please fill out the below information to register your child(ren) for camp.

Parent/Guardian Information

First Name

Last Name

Phone Number

Address

Apartment, suite, etc.

City

State

Postal / Zip Code

Do you currently attend church?

What church do you attend?

In case of an emergency with your child(ren), whom should we call?

First Name

Last Name

Phone Number

Relationship to child(ren)

Child/Children Information

How many children would you like to register?

Child 1 Information: Grade Entering (Fall 2024)

Child 1 Name (First and Last)

Child 1 Date of Birth (MM/DD/YYYY)

Child 1 Gender

Are there any special learning or medical needs we should be aware of? (Child 1)

Please Explain the learning or medical needs (Child 1)

Does your child have any allergies we should be aware of? (If the allergy is significant, we request that you provide your child's snack each day.) (Child 1)

Please Explain the allergy (Child 1)

Child 2 Information: Grade Entering (Fall 2024)

Child 2 Name (First and Last)

Child 2 Date of Birth (MM/DD/YYYY)

Child 2 Gender

Are there any special learning or medical needs we should be aware of? (Child 2)

Please Explain the learning or medical needs (Child 2)

Does your child have any allergies we should be aware of? (If the allergy is significant, we request that you provide your child's snack each day.) (Child 2)

Please Explain the allergy (Child 2)

Child 3 Information: Grade Entering (Fall 2024)

Child 3 Name (First and Last)

Child 3 Date of Birth (MM/DD/YYYY)

Child 3 Gender

Are there any special learning or medical needs we should be aware of? (Child 3)

Please Explain the learning or medical needs (Child 3)

Does your child have any allergies we should be aware of? (If the allergy is significant, we request that you provide your child's snack each day.) (Child 3)

Please Explain the allergy (Child 3)

Child 4 Information: Grade Entering (Fall 2024)

Child 4 Name (First and Last)

Child 4 Date of Birth (MM/DD/YYYY)

Child 4 Gender

Are there any special learning or medical needs we should be aware of? (Child 4)

Please Explain the learning or medical needs (Child 4)

Does your child have any allergies we should be aware of? (If the allergy is significant, we request that you provide your child's snack each day.) (Child 4)

Please Explain the allergy (Child 4)

Child 5 Information: Grade Entering (Fall 2024)

Child 5 Name (First and Last)

Child 5 Date of Birth (MM/DD/YYYY)

Child 5 Gender

Are there any special learning or medical needs we should be aware of? (Child 5)

Please Explain the learning or medical needs (Child 5)

Does your child have any allergies we should be aware of? (If the allergy is significant, we request that you provide your child's snack each day.) (Child 5)

Please Explain the allergy (Child 5)

Child 6 Information: Grade Entering (Fall 2024)

Child 6 Name (First and Last)

Child 6 Date of Birth (MM/DD/YYYY)

Child 6 Gender

Are there any special learning or medical needs we should be aware of? (Child 6)

Please Explain the learning or medical needs (Child 6)

Does your child have any allergies we should be aware of? (If the allergy is significant, we request that you provide your child's snack each day.) (Child 6)

Please Explain the allergy (Child 6)

Child 7 Information: Grade Entering (Fall 2024)

Child 7 Name (First and Last)

Child 7 Date of Birth (MM/DD/YYYY)

Child 7 Gender

Are there any special learning or medical needs we should be aware of? (Child 7)

Please Explain the learning or medical needs (Child 7)

Does your child have any allergies we should be aware of? (If the allergy is significant, we request that you provide your child's snack each day.) (Child 7)

Please Explain the allergy (Child 7)

Release to use photos and videos

I hereby grant permission to August Gate Church to use photographs and/or video taken of me or my children (listed above) during the week of AG Kids Camp (June 24-28, 2024) in publications, news releases, online, and in other communication related to the mission of August Gate Church.

I agree

I do NOT agree

How did you hear about AG Kids Camp?

Please explain

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AG Kids Camp Registration

Parent/Guardian Information

Child/Children Information

Release to use photos and videos

How did you hear about AG Kids Camp?

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