Registration Form
Camp Pineshore Bible Camp: Registration for Day and/or Overnight Camp
Parental Information
Parents or Guardian Name
*
First Name
Last Name
Parent or Guardian Address
*
Street Address
Street Address Line 2
City
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State
Zip Code
Parent/ Guardian Phone #
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Picking up and dropping off my camper(s) will be:
*
Camper Information
How many Campers are you registering?
*
Please Select
1
2
3
4
Camper 1 Information
Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Grade beginning in Fall 2024
*
Enter Grade 1-First Year of College
Camper 2 Information
To Register Additional Siblings
Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Grade beginning in Fall 2024
*
Enter Grade 1-First Year of College
Camper 3 Information
To Register Additional Siblings
Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Grade beginning in Fall 2024
*
Enter Grade 1-First Year of College
Camper 4 Information
To Register Additional Siblings
Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Grade beginning in Fall 2024
*
Enter Grade 1-First Year of College
Signature
*
Date of Signature
*
-
Month
-
Day
Year
Date
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Which camp week(s) will {name41} be registering for?
*
Day Camp: June 24-28: For Campers going into 1-6 Grade: $200
Day Camp: July 1-5 (July 4th off): For Campers going into 1-6 Grade: $160
Day Camp: July 8-12: For Campers going into 1-6 Grade: $200
Day Camp: July 15-19: For Campers going into 1-6 Grade: $200
Day Camp: July 22-26: For Campers going into 1-6 Grade: $200
Overnight Camp-Sunday School Week: July 28-August 2: For Campers going into 3-6 Grade: $400
Overnight Camp-Junior High Week: August 4-9: For Campers going into 7-9 Grade: $400
Overnight Camp-Senior High Week: August 11-16: For Campers going into Grade 10 to Graduating High School: $400
Which camp week(s) will {name52} be registering for?
*
Day Camp: June 24-28: For Campers going into 1-6 Grade: $160 (Sibling discount)
Day Camp: July 1-5 (July 4th off): For Campers going into 1-6 Grade: $128 (Sibling Discount)
Day Camp: July 8-12: For Campers going into 1-6 Grade: $160 (Sibling discount)
Day Camp: July 15-19: For Campers going into 1-6 Grade: $160 (Sibling discount)
Day Camp: July 22-26: For Campers going into 1-6 Grade: $160 (Sibling discount)
Overnight Camp-Sunday School Week: July 28-August 2: For Campers going into 3-6 Grade-$320 (Sibling Discount)
Overnight Camp-Junior High Week: August 4-9: For Campers going into 7-9 Grade: $320 (Sibling Discount)
Overnight Camp: Senior High Week: August 11-16: For Campers going into Grade 10 to Graduating High School: $320 (Sibling Discount)
Which camp week(s) will {name59} be registering for?
*
Day Camp: June 24-28: For Campers going into 1-6 Grade: $160 (Sibling discount)
Day Camp: July 1-5 (July 4th off): For Campers going into 1-6 Grade: $128 (Sibling Discount)
Day Camp: July 8-12: For Campers going into 1-6 Grade: $160 (Sibling discount)
Day Camp: July 15-19: For Campers going into 1-6 Grade: $160 (Sibling discount)
Day Camp: July 22-26: For Campers going into 1-6 Grade: $160 (Sibling discount)
Overnight Camp-Sunday School Week: July 28-August 2: For Campers going into 3-6 Grade: $320 (Sibling Discount)
Overnight Camp-Junior High Week: August 4-9: For Campers going into 7-9 Grade: $320 (Sibling Discount)
Overnight Camp-Senior High Week: August 11-16: For Campers going into Grade 10 to Graduating High School: $320 (Sibling Discount)
Which camp week(s) will {name66} be registering for?
*
Day Camp: June 24-28: For Campers going into 1-6 Grade: $160 (Sibling Discount)
Day Camp: July 1-5 (July 4th Off): For Campers going into 1-6 Grade: $128 (Sibling Discount)
Day Camp: July 8-12: For Campers going into 1-6 Grade: $160 (Sibling Discount)
Day Camp: July 15-19: For Campers going into 1-6 Grade: $160 (Sibling Discount)
Day Camp: July 22-26: For Campers going into 1-6 Grade: $160 (Sibling Discount)
Overnight Camp: Sunday School Week: July 28-August 2: For Campers going into 3-6 Grade: $320 (Sibling Discount)
Overnight Camp-Junior High Week: August 4-9: For Campers going into 7-9 Grade: $320 (Sibling Discount)
Overnight Camp: Senior High Week: August 11-16: For Campers going into Grade 10 to Graduating High School: $320 (Sibling Discount)
Total
Grand Total
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( X )
USD
Total Camper Fee for Camp Pineshore Bible Camp
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