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 4 - Teen Adventure - July 29-Aug 2nd - Speaker Kurt Copeland.
Camper Information
Camper Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birth Date
*
-
Month
-
Day
Year
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 Name
Last Name
Address ( if different from camper )
Street Address
Street Address Line 2
City
State / 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 Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Consent and Sign
Signature
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.
Week Selection and Checkout
My Products
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Adventure Teen Week
July 29th- Aug 2nd
$
155.00
Themed T-shirt
$
25.00
Swag Pack
Includes - Theme shirt, FW drawstring bag, FW reusable water bottle, FW hat, FW sticker.
$
50.00
Snack Shop
You may add money for your campers snack shop card here, or you can send them with cash later.
$
10.00
$10.00 X
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Submit
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