Kempsville Baptist Church - Basketball Camp Registration

Registration

Participant's First Name

Participant's Last Name

Parent/Guardian's Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Participant's Birthdate

Grade Completed June 2025

Participant's T-shirt Size

Participant's Gender

Allergies, Medical, Special Needs

Emergency Contact

Emergency Contact's Phone Number

Authorized Pickup (person other than emergency contact)

Do you attend church? If so, where?

Do we have your permission to photograph your child?

Yes

Do we have your promission to use your child's photograph in our church publications (basketball camp promos & webpage)?

Yes

Extra Comments