Sports Outreach

201 Lake Mills Road, Chuluota, FL 32766, 407-365-8323

Summer Evening Sports Camp, June 28th - July 2nd, 6:00 - 8:00 p.m.

For more information:

Call the Church office at 407-365-8323

Complete and Submit the form below

Child's Name
Street Address
Mailing Address (If Different)
Home Phone #
Parent/Guardian's Cell or Work Phone #

Birth Date

Month Day Year

Last grade completed in school

(K;1;2;3;4;5;6;7;8,9,10,11,12)

Does your child regularly attend Church or Sunday School?

If so, where?

Medical or other information we need to know:

Who may pick up this child at the end of each day's activities?

Name:

Phone:

Name:

Phone:

In the event of an emergency, whom do we call?

Parent/Guardian's Name
Phone:

Secondary Contact:
Phone: