Summer Quest

July 16 – 20, 2012

9:00 am – 4:00 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 Shirt Size

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

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                                                            $175 per child      

Box 69                                                                                                             

Fanwood, NJ 07023                                                                                       

Make checks payable to Fanwood Presbyterian Church. For more information, please contact Caroline Unzaga, Youth Director, at CarolineUnzaga@gmail.com