Our Lady of Mount Carmel window
OLMC Summer Bible Camp 2013 - Registration
OUR LADY OF MOUNT CARMEL CHURCH
SUMMER BIBLE CAMP 2013
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DATE: JUNE 17 - JUNE 21
PLACE: CASEY HALL - 728 Belmont Ave.
TIME: 9:00 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
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TUITION: One Child -------------- $ 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 _______________________________