Jumpin' June Registration Form

STOP!!! If you are looking for the Summer Enrichment Program or the FCS Summer School program, THIS IS NOT IT. This is only a week-long day camp that has nothing to do with FCS. You must check the FCS website to find out about registering your child for summer school.

Join Harbor Light's Children's Ministries Department for 5 days of fun and games.

  • We will be going to Chuck E. Cheeses in San Jose on Tuesday, June 16. Your child will not need to bring a lunch (unless they have allergies), but money for extra tokens is welcome because each child only receives 20.
  • Thursday's field trip will be to Cloverleaf Bowling in Fremont. When you register below, please give us your child's shoe size. That will assist us in giving the kids the most time to bowl when we arrive.

Call Children's Ministries if you have any questions: (510) 744-2233.

Pay by check: You may print out a registration form at home and drop it off with a picture of your child(ren) and your payment (made out to Harbor Light) in the Business Office slot which is open 24/7, or you may mail it to Harbor Light Church, Attention: Children's Ministries, 4760 Thornton Avenue, Fremont, CA  94536.

Pay by credit card:  Fill out the form below. When you hit the Submit button at the bottom you will be directed to a page that will allow you to complete the registration by paying with your credit card. If you do not want to pay with a credit card, DON'T FILL OUT THE FORM BELOW.

Camp I am registering for:  

Name of Child:       Grade:     Age: 

Shoe Size of First Child: 

Name of Child:       Grade:      Age: 

Shoe Size of Second Child: 

Name of Child:       Grade:      Age: 

Shoe Size of Third Child: 

Name of Parent or Guardian: 

I will need Before/After Childcare

Permission Slip and Medical Release Form:

I,  give my permission for   to be part of the  program at Harbor Light Assembly of God.  I hereby authorize the leaders of the group to take the above named child(ren) to a doctor or hospital for treatment in case of emergency.

Doctor's Name:       Dr. Phone: 

Health Ins. Co:       Group No.: 

Parent's Work No.:       Parent's Cell: 

Allergies of Child(ren): 

Additional Comments/Concerns: 

REFUND POLICY FOR CREDIT CARD PAYMENTS:

When you register and pay by credit card, but are unable to attend the camp you've registered for, we are not able to refund your money. You are welcome to apply your payment to another camp in 2009.

I have read and understand the refund policy that applies to credit card payments (above)

First Day Notes:  You'll need to bring in pictures of each child, waiver form (if applicable), and sign this permission slip when dropping off your child.


Enter the numbers as they
are shown in the image above