Summer Camp Detailed Registration Form

Camper’s Name

First NameLast Name
Birth Date

MonthDayYear
MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Is the camper prescribed an inhaler? If yes, please explain any instructions.
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Camp Rules:

Please do not bring cell phones or any electronic devices to camp
PACK FOR CAMP!
- Beach towel
- water shoes
- hiking shoes
- boots with heal
- t-shirt to tie-dye
- backpack
- sunscreen
- bug spray
- sleeping bag
- pillow
- Bible
- swimsuit
Type a question
My Products*
prevnext( X )
May 19-23
5 day overnight Camp for girls 6-13 May 12-16, 2024

$450.00 Quantity
Item subtotal:$0.00

June 16-20
5 day overnight camp girls 6-13 June 16-20

$450.00 Quantity
Item subtotal:$0.00

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty: