OLMC Summer Bible Camp 2010 - Registration
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OUR LADY OF MOUNT CARMEL CHURCH
SUMMER BIBLE CAMP 2010
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DATE: JUNE 21 - JUNE 25
PLACE: CASEY HALL - 728 Belmont Ave.
TIME: 8:30 AM – 12:00 NOON
FOR: FOUR YEARS OLD TO GRADE 5
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For Information Contact: Razia Khokhar
773-525-0453 Ext. 14
email: olmcreledu@aol.com or
Maria Leticia Trevino
773-348-3302 or email
mltg68@hotmail.com
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TUITION: One Child -------------- $ 100. 00           

Early Registration by May  ---------- $ 75. 00
After May Registration                    $ 100.00
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Office Use
Tuition as Follows   Ck# _________   Paid $   _________
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FAMILY INFORMATION:      (Please Specify Full Legal Names) 
Your Email ___________________________________
Mother’s Ph. # ________________________________
Father’s Ph. # _________________________________
Emergency Ph. #_______________________________
Emergency Ph. #_______________________________ 
Father’s Last Name______________________ First Name _______________
Religion __________________________________
Street Address ____________________ City, State,Zip __________________
(W) Phone # _______________________________
(H) Phone #_____________________________ 
Mother’s Last Name ______________________ First Name __________________
Religion __________________________________  
(W) Phone # _______________________________
(H) Phone #_____________________________  
Language Spoken at Home ___________________  

WHO WILL PICK UP CHILD FROM SCHOOL____________________________
Relationship to child_____________________________________

PLEASE COMPLETE THE INFORMATION ABOUT YOUR CHILD      
(Please Specify Full Legal Name) 
Child’s Name________________________________________
Sex: M ___F ___ Grade Level ______  
School Attending ________________________________________________________ 
Birth Date _______________ City/State of Birth _______________________________