(Group) Summer Week 4 - Teen Adventure - July 29-Aug 2nd

Camper Registration

This form is for an individual camper attending with their church group. If you are filling out this form please get with your leader to workout payment. If you are registering more than one child you will complete this form once for each child attending.

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.

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.

Group Information
This section only needs to be filled out if you're attending with your church group and your leader is collecting money
What church are attending with?
Church City and State location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your leader's name who is bringing your group to camp?
In the next "payment" section you may select to add Snack shop money or swag items for your camper, but you do not have to pay for the week attending. Please see your church leader for payment details.

Camper Registration