Peaceful Beginnings Early Childhood Center Summer Camp Registration Form Please complete and submit. Name of Child(ren) * Gender * Male Female Age * Birth Date * MM DD YYYY T-Shirt Size * Name of Child(ren) Gender Male Female Age Birth Date MM DD YYYY T-Shirt Size Name of Child(ren) Gender Male Female Age Birth Date MM DD YYYY T-Shirt Size Parents/Guardians * Address * Email Address for Statements * Phone * Mother's Work Place & Address * Work Phone Number * Cell Phone Number * Driver's License Number * Father's Work Place & Address * Work Phone Number * Cell Phone Number * Driver's License Number * Home Church (if not applicable, put N/A) * Childcare * Childcare is available from 6:30 AM to 6:00 PM Monday through Friday, ages 6 weeks-13 years. Please check one: Full-Time (5 days per week) Part-Time Thank you for submitting! A staff member will be in touch soon.
