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Child's Name * First Last
Sibling Name First Last
If there is another child in your household who will be participating in Create, please input their name here.
Sibling Name First Last
If there is another child in your household who will be participating in Create, please input their name here.
Parent Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *

We won't SPAM you. This email will only be used for Create related contact.
Emergency Contact *
Phone Number * ### - ### - ####
This should be a number we can contact before Create, as well as for an emergency contact during camp.
Payment Method *

Each child is $15 and there is a family cap of $25. All payments should be made in person at The Well prior to July 26th (payment can be place in the Box of Jubilee before or after worship, or by appointment). Please make checks out to The Well and put "Create" in the Memo line. You can also mail payments to:

The Well
190 Sierra Court Suite C2
Palmdale, CA 93550
Prayer Requests
Maximum Allowed: 300 words. Currently Used: 0 words.

If there is any way that we can pray for you, just let us know! Our Create team is actively praying for this ministry and would love to pray for you and your family for whatever is going on in your life. God is listening.
Do Not Fill This Out

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