Harvest Life International Church

camp is july 26-28 $100 per Child

Fill out the information below and someone will get back with you with.

Parent or Legal Guardian's First Name

Last Name

Relationship
Father
Mother
Legal Guardian

1st. Child's Name

Date of Birth / Grade

2nd. Child's Name

Date of Birth / Grade

3rd. Child's Name

Date of Birth / Grade

4th. Child's Name

Date of Birth / Grade

Address 1

Address 2

City

State

Country

Zip/Postal Code

Cell

Work

Does your child have any medical issues we should be aware of?

I give permission for the above child(ren) to ride Harvest Life International Church's bus and to attend all services/events.
I Agree