2024 SCC Junior Camp - CAMPER Registration Form
THERE WILL BE AN EXPRESS REGISTRATION LANE AT CAMP
You can only use the express lane if you have paid ALL FEES online including t-shirt, picture and snack bar (if selected) in advance. Payments can be made at camp as well, but will go through the traditional check-in line which will take quite a bit longer.
MISC INFO
Ages allowed, 7-12 years of age. In the past we have allowed some 13 year olds to attend but this year we have a strict 12 year old upper limit. Application must be completely filled out to be accepted. We will be following up with all pastors to verify applicants. All T-Shirt money MUST BE TURNED IN BY JUNE 1, 2024 or your shirt order WILL NOT BE PLACED. Registration, picture and snack money can be turned in later if necessary.
Dropoff & Pickup Date / Time
DROPOFF: Monday, June 17 between 3pm and 5pm | PICKUP: Friday, June 21 before 9am
PAYMENT INFO
Payments for registration ($220 per camper) and t-shirts / pictures IF ordered ($25 per shirt & $12 for camp picture) can be made online OR by check or cash payments by mail to: SoCal Commission Attn: SCC Jr Camp 1123 S. Cactus Ave Rialto, CA 92376. You can also pay at camp if necessary.
DEPOSIT INFORMATION
A minimum deposit of $110 is required by June 1, 2024
Camper Name
*
First Name
Last Name
Email Address
*
example@example.com
Gender
*
Please Select
Male
Female
Camper Birth Date
*
Please select a month
January
February
March
April
May
June
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October
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December
Month
Please select a day
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Day
Please select a year
2024
2023
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Year
Age
*
Please Select
6
7
8
9
10
11
12
13
Do you agree to all of the camp rules in the "PACKING LIST, CAMP RULES AND HEALTH HISTORY FORM" file found on SoCalCommission.com/jrcamp?
*
Please Select
Yes
No
Emergency Contact Phone
*
Emergency Contact & Relationship
*
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide any physical or dietary restrictions you have
If this child would like to be in the same cabin as another camper please write their name here... [Note. There is no guarantee of this and campers must be of same gender and within 1 year of their age]
PLEASE ONLY PUT ONE NAME
Do you have Medical Insurance?
*
Please Select
Yes
No
Insurance Company
Insurance Policy Number
Parent or Guardian Name
*
I am the legal guardian of the above-named child and I consent to the camp staff giving such health care to my child as I would normally give in my home (see checkout disclaimer below) [TYPE YES IF YOU AGREE]
*
What Church do you attend and what is the pastor's name (if not on list, type it in the "Other" field below)
*
Please Select
2nd Chance - Pastor Johhny Walker
Apostolic Lighthouse Church of Oildale - Pastor Tyler Hodge
California City - Pastor Andrew Chavez
Faith Mountain - Pastor Paul Bertram
First Pentecostal Church - Pastor Kevin Bradford
Hilltop Tabernacle - Pastor Joel Buxton
Hope Center - Pastor Brandon Wilmoth
Inland Lighthouse Church - Pastor Joel Booker
The Lighthouse Church of Ventura - Pastor Sam Howard
The Lighthouse Church Yucaipa - Pastor Patrick Garrett
Truth Church - Pastor Clifford Clark
Truth Church Shafter - Pastor Frank Cabrerra
Two Mile Apostolic - Pastor Andrew Goodwin
Victory Apostolic Church - Pastor Tim Smith
OTHER
Church not listed (type in Church and Pastor's name)
Does your pastor know and approve of the child listed attending this camp?
*
Please Select
Yes
No
Payment
My Products
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Camp Registration Fee
$
220.00
Camp Deposit Only
$
110.00
Camp Picture
$
12.00
Quantity
1
2
3
4
5
6
7
8
9
10
Snack Bar
$
10.00
Quantity
Price
$10
1
2
3
4
5
6
7
8
9
10
$
10.00
$20
1
2
3
4
5
6
7
8
9
10
$
20.00
$30
1
2
3
4
5
6
7
8
9
10
$
30.00
$40
1
2
3
4
5
6
7
8
9
10
$
40.00
$50
1
2
3
4
5
6
7
8
9
10
$
50.00
$60
1
2
3
4
5
6
7
8
9
10
$
60.00
GO CRAZY!
1
2
3
4
5
6
7
8
9
10
$
100.00
Camp T-Shirt
$
25.00
Size
Quantity
Youth XS
1
2
3
4
5
6
7
8
9
10
Youth S
1
2
3
4
5
6
7
8
9
10
Youth M
1
2
3
4
5
6
7
8
9
10
Youth L
1
2
3
4
5
6
7
8
9
10
Youth XL
1
2
3
4
5
6
7
8
9
10
Adult S
1
2
3
4
5
6
7
8
9
10
Adult M
1
2
3
4
5
6
7
8
9
10
Adult L
1
2
3
4
5
6
7
8
9
10
Adult 2XL
1
2
3
4
5
6
7
8
9
10
Adult 3XL
1
2
3
4
5
6
7
8
9
10
Credit Card
By submitting this registration you agree to the following:
I, the parent or guardian mentioned on the form, am the legal guardian of the above-named child(ren) and I consent to the camp staff giving such health care to my child as I would normally give in my home. If any further medical care is deemed necessary in the judgment of the camp staff, I hereby give consent for that medical care by a physician selected by the camp administrators.You also MUST bring the filled out and signed Health history form with you to camp.
Submit Form
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