Camp Rock 2026 - Camper Registration

June 23rd - 26th, 9am-Noon | Rock Bible Church
4100 First St
Pleasanton, CA 94566

Please complete a form for each Camper.

To be guaranteed a t-shirt,
Campers must be registered
and paid by Sunday, June 7th!

Questions?
Email Megan Ash at
megan@rockbiblechurch.com.

Child's Name

Child's Birthdate (MM/DD/YYYY)

Child's Gender

Please select one option.

Male Female

Grade in Fall 2026

Please select one option.

Pre-K T-K Kindergarten 1st 2nd 3rd 4th 5th 6th

T-Shirt Size

Please select one option.

Child XS (2/4) Child S (6/8) Child M (10/12) Child L (14/16) Child XL (18/20) Adult XS Adult S Adult M Adult L

Does this child have allergies or helpful information to be aware of?

Please select one option.

Yes No

If "Yes," please list below

Does this child carry an EpiPen for allergic reactions?

Please select one option.

Yes No

Child's Medical Provider

Child's Medical ID #

Name of a friend your child would like to be grouped with

Guardian's First Name

Guardian's Last Name

Guardian's Relationship to the Child

Please select one option.

Parent Grandparent Relative - other Close Family Friend

Guardian's Address

Guardian's Email

This address will receive a confirmation email

Guardian's Phone Number

Emergency Contact Phone Number

Registration & T-Shirt

Online - preferred ($70) Via check ($0 now) Wed-Fri ($50) Thurs-Fri ($30) Fri ($16)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 23rd - 26th, 9am-Noon

Rock Bible Church
4100 First St
Pleasanton, CA 94566

Please complete a form for each Camper.

To be guaranteed a t-shirt,
Campers must be registered
and paid by Sunday, June 7th!

Questions?
Email Megan Ash at
megan@rockbiblechurch.com.

Camp Rock 2026 - Camper Registration

Description

Please Fix the Following