Date:                        

 August 11th - 14th

 9:00am - 12:30pm each day
  Ages:       

 Kindergarten thru 6th graders    

  Cost:

 Free!!

  Contact:

 John Coulliette

 (503) 625-9956

 johnc@timberlinebaptist.net

Parent or Legal Guardian*


Street Address*


City*                                                   State*      ZIP*
         

1st Child's First & Last name*          Grade*             Shirt Size*

        

2nd Child's First & Last Name          Grade               Shirt Size
      

3rd Child's First & Last Name           Grade               Shirt Size
       

4th Child's First & Last Name           Grade               Shirt Size
       

5th Child's First & Last Name           Grade               Shirt Size
       
 
6th Child's First & Last Name           Grade               Shirt Size
       

EMERGENCY CONTACT*
Name 

Phone      Ext

*Required

Phone Number(s)*
Work
     Home Email Address