Touching Heart is excited to announce the launch of our summer service camp!

Date: July 17-21, 2017

Time: Camp: 9am-3pm Aftercare: 3pm-5pm

King of Kings Lutheran Church
4025 Kings Way
Fairfax, VA 22033

Check out our camp flyer!

Register for Summer Service Camp below:

Child's Name*

Child's Age*

Child's School Grade*

Parent's Name*

Parent's Email*

Parent's Contact Number*

Parent 2 Name*

Parent 2 Email*

Parent 2 Contact Number*

Parent’s Mailing Address*




Emergency Contact Name*

Phone 1*

Phone 2*

Emergency Contact 2 Name*

Phone 1*

Phone 2*

Any known allergies or health concerns?

Any medication that will need to be with the child during the camp? (Such as epipen, inhaler, etc...)

Is there anything else we need to know about your child?
(ie: specific needs, accomodations required, dietary modifications, etc...)

Person(s) authorized to pick up child at end of day.

Camp Cost: $250After care (3pm-5pm): $50

Will your child will stay for aftercare from 3pm-5pm? Cost is an additional $50

I have read and agree to the releaseAgree

I understand that by signing up for the camp, my child will be photographed for Touching Heart marketing.

*NOTE* Submitting this form will register your child for this event and take you to our PayPal page for payment. Your child's spot is not confirmed until you receive a receipt of payment from PayPal.

Submit without aftercare:

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Submit with aftercare:

[paypalsubmit itemamount:fee-paypal-extra]