Christian Community Experience 2022

Christian Community Experience: July 17-22, 2023
Camper Information

*for youth, staff, and adults
Camper Name*

First NameLast Name
What name would you like to be called? (If same as legal name leave blank)
Sex
Birth Date*

MonthDayYear
Camper Email
Camper Cell Phone

Area CodePhone Number
Grade you will have completed in June of 2022*
Have you attended CCE before?*
Local Church Affiliation
Special dietary needs:
Allergies:
Medical, Emotional, and Mental Health (please include any health info that we need to know)
Fun fact about you (that you’re ok with sharing)
T-Shirt*
Do you have a hard copy of a Bible to bring with you to camp?*

Yes, I doNo, but I will get one before campNo, and I would like to get one at camp
On the contact list to be shared with staff and campers please use:*

Camper's phone # and emailParent's phone # and emailNo contact information
FOR CAMPER: I agree to follow the direction of the camp staff, and I agree to participate in all camp activities and to obey safety regulations, including but not limited to the Code of Conduct for Campers and all Covid-19 Safety Precautions (see links below).*

YesNo
Code of Conduct for Campers

Code of Conduct for Staff

Covid-19 Safety Precautions

Parent/Guardian Emergency Contact Info

*youth fill out as parent/guardian emergency contact, staff and adults fill out as emergency contact
Parent/Guardian Name*

First NameLast Name
Relationship*
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Alternate Emergency Contact if Applicable
Alternate Contact Phone Number
Camper Lives With (the names of your parent, parents, or guardian)

For Parent/Guardian
I/We give full permission for our son/daughter to attend camp, participate in activities and group photo:*

Yes
Photographs may be used in camp publicity: *

YesNo
I/We give permission to share contact information with other campers and staff*

YesNo
Payment Types*
prevnext( X )
Check $ Free

Online$332.50
Note: Cost of camp is $325 plus $7.50 registration fee due to the cost of online registration.
Notice! Due to the costs of online registration a fee of $7.50 will be added to the total.

Once you "Submit Form" you will redirected to PayPal.com. On the "Add a Note" section in PayPal please note that this payment is for "CCE for [Camper's Name]."
Pay by Check - $325.00

Please put your camper's name in the memo line and make your checks payable to Camp Caney and mail them to Camp Caney 1163 Methodist Camp Road, Minden, LA 71055. (This information will be emailed to you once you click "Submit Form").
By submitting this form, I agree that I have read and will abide by the Camp Caney Code of Conduct for Campers or the Code of Conduct for Staff and I will abide by all Covid-19 Safety Precautions.
Should be Empty:

Christian Community Experience: July 17-22, 2023