Summer Week 1 - Teens - July 7-11th

Camper Registration

This form is for an individual camper and payment. If you are registering more than one child you will complete this form and pay once for each child attending.
Summer Week 1, Teens, July 7-11th, Speaker Al Stone,

Camper Information
Camper Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Date
Grade Entering *
Does this camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is this camper prescribed an inhaler? If yes, please explain any instructions.

Parent/Guardian Information
Name*

First NameLast Name
Address ( if different from camper )

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How did you hear about us? (google, facebook, friends, church, ect.)
If a Church type the name of your church

Emergency Contact
Emergency Contact

If we cannot get ahold of parent/guardian, this will be our second contact.
Relation to Camper
Emergency Contact*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.

Consent and Sign
Signature

Clear
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

My Products*

Teen Week July 15th-19th

$145.00

Themed T-shirt

$25.00

Swag PackIncludes - Theme shirt, FW drawstring bag, FW reusable water bottle, FW hat, FW sticker.

$50.00

Snack ShopYou may add money for your campers snack shop card here, or you can send them with cash later.

$10.00 $10.00 X

Total

$0.00

Credit Card

Apple Pay

Google Pay

Camper Registration