Summer Camp Detailed Registration Form

Camper’s Name

First NameLast Name
Birth Date

MonthDayYear
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
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*
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May 19-235 day overnight Camp for girls 6-13 May 12-16, 2024
$450.00 Quantity
Item subtotal:$0.00

June 16-205 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: