Language
English (US)
Poiema Camper Application
Hello! We are excited you have decided to apply for Camp of The Hills discipleship and service program! Please answer each question clearly. (You must be between 15 and 18 years of age to apply).
Participant Information
Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Please enter a valid phone number.
Email
example@example.com
Parent/Guardian Information
Name
First Name
Last Name
Relation to the Camper
Please Select
Mother
Father
Grandma
Grandpa
Foster Parent
Aunt
Uncle
Other
If other, explain...
Phone Number
Please enter a valid phone number.
Email
example@example.com
Tell Us More
How do you know about Camp of the Hills?
Have you been to Camp of the Hills before? If so, what were you here for?
Why do you want to be a Poiema Camper this Summer?
What do you want to gain from this program?
Available Sessions
Please select the available dates that work best for you:
Session 1: June 5th-17th
Session 2: June 19th-July 1st
Session 3: July 10th-22nd
Session 4: July 24th- August 5th
Submit
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