Camp Bailey Registration

Step 1 of 5

Parent/Guardian Information

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Name

First Last

Phone

Address

Street Address Address Line 2 City State ZIP Code

Parent/Guardian with legal custody

Parents Are

Emergency Contacts in NWA

(Other than parents or guardians)

Name(Required)

First Last

Phone(Required)

Relationship to Child(Required)

Name(Required)

First Last

Phone(Required)

Relationship to Child(Required)

Camper Pick-Up Information

Please list below the people who *DO HAVE PERMISSION* to pick up your camper. *Note Anyone picking up your camper must have a picture ID.

Name

First Last

Phone

Relationship to Child

Name

First Last

Phone

Relationship to Child

Name

First Last

Phone

Relationship to Child

Activities Release & Field Trip Permission

Photographic Waiver

DHS Acknowledgements

Signature(Required)

Camp Bailey Registration

Price: $0.00

Payment Details

Subtotal

$0.00

Processing Fee

$0.00

3.5% Processing fee on Credit/Debit card transactions

Total

Coupon

Credit Card

Cardholder Name

Card Details

CAPTCHA

Camper's Full Name	Date of Birth	T-Shirt Size	Is your camper a Hedgehog OR Hoglet	Does your camper have any allergies?	Actions

There are no Children.

A Private Christian School in Fayetteville, AR