Dates: Sunday–Friday, July 24–29, 2011

Time: 6:15–8:30 p.m.

Boys & Girls 4 Years Old – 6th Grade (2010-11 school year)

Name:

__________________________________________________________

Age:

_________

Birth Date:

_________________

Grade Last Year:

___________

Street Address:

___________________________________________________

City:

___________________________________________________________

State:

_______________

Zip:

_________________

Home Phone:

______________________

Cell Phone:

_______________________

Home Email Address:

________________________________________________

Parent’s Name:

____________________________________________________

In Case of an Emergency, Contact:

_______________________________________

Food Allergies/Special Needs:

__________________________________________

Home Church:

_____________________________________________________

Print and mail or bring to:

Comite Baptist Church

12250 Greenwell Springs Road

Baton Rouge, LA 70815