Space City Church

YOUTH REGISTRATION FORM

PLEASE FILL OUT ALL INFORMATION TO SECURE CAMPER'S SPOT

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Student's First And Last Name

Gender At Birth

Date Of Birth

Grade Next Fall

T-Shirt Size (Adult)

Is There Anyone Your Child Should Not Be Released To? If Yes, Please List Names.

Medical Information (Please list any chronic/reocurring conditions or special needs, along with any other information you'd like us to know:

Are Activities Restricted?

Does student have any dietary restrictions that require an individual meal?

Dairy Free

Gluten Free

Peanut Free

None

Pleas List Any Additional Allergies

May be given Tylenol?

May be given Benadryl?

May be given Ibuprofen?

Camper may be given over the counter, non-prescription medications or applications, not to exceed the recommended dosage for stomach discomfort, burns, cuts, insect bites, rash or scrapes

List Exceptions

Parent/Guardian First and Last Name

Parent/Guardian Mobile Phone

Parent/Guardian Email

Address

City

State

Zip Code

Emergency Contact (If Parent/Guardian cannot be reached)

Contact Mobile Phone

YOUTH REGISTRATION FORM

Contact Us

Want to learn more about Space City Church? We’re here to help!

Contact

contact@spacecitychurch.com

Address:

Services Are Held At:
7746 Almeda Genoa Rd,
Houston, TX 77075

YOUTH REGISTRATION FORM

Contact Us

Want to learn more about Space City Church? We’re here to help!

Contact

contact@spacecitychurch.com

Address:

Services Are Held At: 7746 Almeda Genoa Rd, Houston, TX 77075

Services Are Held At:
7746 Almeda Genoa Rd,
Houston, TX 77075