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Participant Registration

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Central Baptist Bearden

Location

6300 Deane Hill Drive

Knoxville, TN 37919-4901

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Contact Kim Ponder:

865-588-0586

childrenadmin@cbcbearden.org

First, Tell Us About Yourself:

Parent Information

Thank you for your interest in Central Kids Messy Camp! Campers must have completed K-5th grade. A waiting list will be formed when all spots are filled. In order to reserve each spot, you must pay the $20 registration fee. The remaining balance is due on March 8th. You can pay today through Venmo or bring a check by the Children's Ministry Office. If you have trouble paying the full amount upon registering, please reach out to the Children's Ministry office at childrenadmin@cbcbearden.org

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Do you have a home church, and if so where?

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Would you like more information about Central Bearden?

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Tell Us About Your Participant

First Name

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Last Name

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Grade Leaving

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Gender

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Date Of Birth

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Shirt Size

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Allergies

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Medical Concerns or Special Needs

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