JH Day Trip

Student Information

Name

Grade

7 8

Gender

Male Female

Birthdate

Phone

Allergies

Parent Information

Name

This address will receive a confirmation email

Phone

Address

Name of Emergency Contact

Relationship to Student

Phone

Photo Consent

I give permission for photos and/or videos of my child to be used in Bethlehem Covenant Church publications, and promotional materials, including both print and video on our website online or on social media.

Photo Consent

Yes No

Registration Cost

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

August 18, 10:30am - 8pm

Please fill out this form and click submit.
Cost: $25 + money for one meal
Location: Meeting at BCC then traveling to Watertown, SD.

JH Day Trip

Description

Please Fix the Following