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Harvest Assembly

PENTECOSTAL CHURCH

61 Curlew Drive, North York ON, M3A 2P8

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Students

Children's Ministry

Children's Summer Day Camp 2023 Registration Form

Child's Full Name

Date of Birth (month/day/year)

Age (4-12)

Gender *

Male

Female

Address

Postal Code

Parent(s)/Guardian Names

Home Phone Number

Parent’s Cell Number

Parent's Email Address (home/work)

Health Card Number

Allergies/food restictions or medical conditions we should be aware of:

In case of an emergency, contact:

Is your child bringing any medication? *

No

Yes

If yes, please list:

Permission to take photos of Children to be shown in Church only *

Yes

No

Please list the people who have permission to pick up your child at the end of the day

Parent(s)/Guardian Signature

Date

Print Name

Thanks for registering!

Questions? Email: harvestchildrensmin@gmail.com

This form no longer accepts submissions.

ABOUT US

Harvest Assembly is affiliated with the Pentecostal Assemblies of Canada

ADDRESS

61 Curlew Drive, North York ON, M3A 2P8

Phone: (416) 441-2001

Email: harvest@harvestassembly.ca

CONNECT

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