July 22-26 from 6:00 - 8:30 pm Wesley United Methodist Church, 300 Rhoads Ave., Selinsgrove, PA  570-374-8015 wesleyum@ptd.net


July 22-26 from 6:00 - 8:30 pm Wesley United Methodist Church, 300 Rhoads Ave., Selinsgrove, PA

570-374-8015 wesleyum@ptd.net

Child's Name *
Child's Name
Address
Address
Phone
Phone
name address and phone number & relationship to child
Name and phone number (can be more than one person)
Received, signed and returned photo/video permission form Received a copy and reviewed safe sanctuary statement