Messiah Lutheran Member Camper Registration Form 2026

Messiah Lutheran Member Registration Summer 2026

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.Format: (000) 000-0000.
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
Date of Birth

MonthDayYear
Date
Grade beginning in Fall 2026
Enter Grade 1-First Year of College
Camper 2 Information

To Register Additional Siblings
Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Grade beginning in Fall 2026
Enter Grade 1-First Year of College
Camper 3 Information

To Register Additional Siblings
Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Grade beginning in Fall 2026
Enter Grade 1-First Year of College
Camper 4 Information

To Register Additional Siblings
Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Grade beginning in Fall 2026
Enter Grade 1-First Year of College
Signature
Date of Signature

MonthDayYear
Date

Pay with PayPal

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

Messiah Lutheran Member Registration Summer 2026