Welcome to Hiawatha Church

Day Camp Registration
Child Information
Last Name:
First Name:
Grade Completed:
Age:
Birthday:
Siblings Attending Day Camp (Names and Ages):
Parent Information
Last Name:
First Name:
Street Address:
City, State and Zip:
Home Phone:
Mobile Phone:
E-mail:
Medical Information
Food Allergies:	Yes No
List:
Medical Concerns:	Yes No
List:
By registering your child you give Day Camp leaders the permission to reproduce and use their image as recorded at Day Camp in future promotional materials. Advance registration is required.

4155 41st avenue south. minnepolis. minnesota. 55406
ph: 612.721.2201 fax: 612.767.2838 email: hiawatha@hiawathachurch.com