Fanwood Presbyterian Church
Summer Quest
July 18 – 22, 2011
9:00 am – 3:00 pm
Youth entering 5th Grade to entering 8th Grade
Parent’s Name _________________________________________________________________
Street Address/Town/Zip _________________________________________________________
E-mail Address_________________________________________________________________
Home phone number ____________________ Cell phone number _______________________
Emergency Name/Telephone _____________________________ ________________________
Church Affiliation ______________________________________________________________
Student’s Name
(entering 5th Grade to
entering 8th Grade) Birth Date Grade in September School attending
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Other than myself, name of person(s) who may pick up this child(ren) from Summer Quest
______________________________________________________________________________
Anything special we should know? (allergies/medical concerns)
______________________________________________________________________________
Parent’s Signature ________________________________________ Date __________________
Please return to: Registration Fee:
Fanwood Presbyterian Church—SQ $200 per child
Box 69
Fanwood, NJ 07023
Please register by June 1, 2011.
Make checks payable to Fanwood Presbyterian Church. For more information, please contact Caroline Unzaga, Youth Director, at Caroline Unzaga @ gmail.com