Camp Registration Form

Camp Registration Form

To book a spot at camp, complete the form below! October 2 (6pm-9pm) October 3 (10am - 8pm) Camp will be held at 1642 J Frank Culpepper Rd, Lake Park, Ga 31636.
Your Name

First NameLast Name
Birth Date

MonthDayYear
Mobile Number
Format: (000) 000-0000.
Email Address
example@example.com
Desired Name Tag
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select Camp shirt size- this is for first time attendees. If you have been to a previous camp and have the purple or navy camp tee design you can skip this section.
Please provide any medical or dietary restrictions you have

Family Information
Parent/Guardian's Name

First NameLast Name
Contact Phone Number
Format: (000) 000-0000.
E-mail Address
example@example.com
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Relationship to Student
Your Reason For Attending This Camp
In 300 words or less, please describe your reasons for wishing to attend this camp.

0/300