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MINISTRY
UPCOMING EVENTS
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GIVE
LIVE
GCT BOOKSTORE
CONNECT
- GCT STAFF
- SERVICES TIMES/ LOCATIONS
OTHER LINKS
- AFFILIATE LINKS
MEMBERSHIP

HOME
ABOUT
MINISTRY
UPCOMING EVENTS
PHOTO GALLERY
GIVE
LIVE
GCT BOOKSTORE
CONNECT
- GCT STAFF
- SERVICES TIMES/ LOCATIONS
OTHER LINKS
- AFFILIATE LINKS
MEMBERSHIP

PARTICIPANT FULL NAME *

HOME PHONE *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

NICK NAME

CHILD'S BIRTH DATE *

AGE *

GRADE *

SCHOOL

Does your child have any allergies (seasonal, food, etc.)? *

Yes
No

If answered "Yes" above, please list allergy here

Other information needed to ensure the proper care of your child:

MOTHER'S NAME *

MAIDEN NAME (SECURITY PURPOSES)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

MEMBER OF GCT?

Yes
No

HOME PHONE *

WHERE EMPLOYED

BUSINESS ADDRESS

BUSINESS PHONE

EMAIL ADDRESS

FATHER'S NAME *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

MEMBER OF GCT?

Yes
No

HOME PHONE *

WHERE EMPLOYED

BUSINESS ADDRESS

BUSINESS PHONE

EMAIL ADDRESS

ARE PARENTS DIVORCED OR SEPERATED?

CHILD RESIDES WITH:

FATHER
MOTHER
BOTH
OTHER

ARE PARENTS DIVORCED OR SEPERATED?

DIVORCED
SEPERATED

WHICH PARENT HAS CUSTODY OF CHILD?

NAMES(S) OF PERSON(S) OTHER THAN PARENT(S) AUTHORIZED TO ACT FOR PARENT IN CASE OF EMERGENCY:

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NAME

HOME PHONE

RELATIONSHIP

WORK PHONE

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Name

HOME PHONE

RELATIONSHIP

WORK PHONE

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NAME

HOME PHONE

RELATIONSHIP

WORK PHONE

Activity Fee $25.00 per child (one-time, nonrefundable)
Please check "Payment: $100" box below to include your payment with your registration.
(*REGISTRATION PAYMENT IS REQUIRED BEFORE FORM CAN BE SUBMITTED!)

Registration and Activity Fee *

Payment: $125

Registration: $100
Activity Fee: $25

Total

$ 0.00

Terms and Conditions *

I understand that those supervising camp activities will exercise a reasonable degree of care. Therefore, I release the director, staff, Bishop Brandon B. Porter, Greater Community Temple, Greater Community Learning Academy and the camp from all liability, and waive any claim against them for any harm or injury which may be sustained by my child while attending Camp Porter. Furthermore, I assume total responsibility for my child’s conduct during his/her attendance at Camp Porter or related trips and activities.