Messiah Member Camper Registration Form 2025

Messiah Fitchburg Member Registration Summer 2025

Camp Pineshore Bible Camp: Registration for Day and/or Overnight Camp
Parental Information
Parents or Guardian Name*

First NameLast Name
Parent or Guardian Address*

Street Address

Street Address Line 2

CityState

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?*
Camper 1 Information
Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Grade beginning in Fall 2025*
Enter Grade 1-First Year of College
Camper 2 Information

To Register Additional Siblings
Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Grade beginning in Fall 2025*
Enter Grade 1-First Year of College
Camper 3 Information

To Register Additional Siblings
Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Grade beginning in Fall 2025*
Enter Grade 1-First Year of College
Camper 4 Information

To Register Additional Siblings
Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Grade beginning in Fall 2025*
Enter Grade 1-First Year of College
Signature*

Clear
Date of Signature*

MonthDayYear
Date

Pay with PayPal

Choose from one of the PayPal options to make your payment.
Should be Empty:

Messiah Fitchburg Member Registration Summer 2025