Bible Camp Registration
This year's theme is "Stellar - Shine Jesus' Light". The dates for this year's camp are July 17 -21 (8:45am - 12pm). We'll be looking for lots of volunteers to put on a great week. Think about how you might want to get involved. And don't forget to "like" us on Facebook to get the latest news right on your "newsfeed". Or visit the page anytime (you don't need a facebook account to view the page.)
Parent/Guardian Information
Head of Household
First Name
Last Name
Gender
Please Select
Male
Female
Preferred Language
Mobile Number
*
Other Phone Number
Email Address
*
example@example.com
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Family Remarks
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Camper 1 Information
Camper 1 Name
First Name
Last Name
Camper 1 Grade
Please Select
TK
1st
2nd
3rd
4th
5th
6th
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Please provide any medical or dietary restrictions/precautions for this camper
If this camper would like to be placed with a friend, please list their name here
Would you like to register an additional camper?
Yes
No
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Camper 2 Information
Camper 2 Name
First Name
Last Name
Camper 2 Grade
Please Select
TK
1st
2nd
3rd
4th
5th
6th
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Please provide any medical or dietary restrictions/precautions for this camper
If this camper would like to be placed with a friend, please list their name here
Would you like to register an additional camper?
Yes
No
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Next
Camper 3 Information
Camper 3 Name
First Name
Last Name
Camper 3 Grade
Please Select
TK
1st
2nd
3rd
4th
5th
6th
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Please provide any medical or dietary restrictions/precautions for this camper
If this camper would like to be placed with a friend, please list their name here
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Next
Emergency Contact Information
Emergency Contact Name
First Name
Last Name
Relationship to Student
Emergency Contact Phone Number
Payment
Your camper's registration is not considered complete until payment is submitted. By clicking SUBMIT you will be redirected to our payment page. Please select the number of registered campers and submit you payment.
Submit Form
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