CCD Teen Camp Leader Registration

CCD Summer Camp Leader Registration
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shirt Size*
Leader's Local Church
Dietary Needs?
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Payment

The cost for adult leaders is $175. This can be paid by the leader or by the local church. Each church should send in one check for their adult leaders to: CCD Teen Camp, c/o Joel Heald, 200 University Avenue, Bourbonnais, IL 60914.
Should be Empty:

CCD Summer Camp Leader Registration