Senior Teen Camp Registration
July 5 - 10, 2025
Camper's Name
*
First Name
Last Name
Sex
*
Male
Female
Birthday
*
-
Month
-
Day
Year
Date
Start of Youth Camp
-
Month
-
Day
Year
Date
Grade completed prior to start of camp
*
If your child has just completed grade 9, they have the option of attending junior or senior teen camp. You know your teen best and you can decide which camp is best for them considering their maturity. If you have any questions, please don't hesitate to contact Amber Machado (executivedirector@mlgc.ca).
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Additional Parent
First Name
Last Name
Alternative Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medication Information
Health Conditions
Health Care Number
*
Issuing Province
*
Please Select
AB
BC
MB
NB
NS
NT
NU
ON
Outside of Canada
PE
QC
SK
YT
Allergies
Dietary Restrictions
Are there any other allergy/dietary restrictions we should know about?
Preferred Roommates
Is this your first time coming to Moose Lake Gospel Camp?
*
Yes
No
Did someone invite you?
Yes
No
Name of the person who invited you
First Name
Last Name
Did you invite a new friend to camp this year?
yes
no
Name of invited friend
First Name
Last Name
MLGC Media Consent & Release Declaration
I have read the MLGC Media Consent & Release Declaration and agree to its contents
*
Yes
No
Are you involved in a church community?
Yes
No
If so, what is the name of your home church?
Would you like to pay via credit card or e-transfer? (Our preference is e-transfer, given the fees from our credit card provider)
*
Credit Card
E-Transer
Regular Price
Early Bird Price
Early Bird Deadline
-
Month
-
Day
Year
Date
Today's Date
-
Month
-
Day
Year
Date
Holding Early Bird Deadline (Needed because of bug in Jotform)
-
Month
-
Day
Year
Date
Holding Today's Date Picker (Needed becaust of bug in Jotform)
-
Month
-
Day
Year
Date
Note: Canteen can be paid for at camp
Fee Due
Camp Registration Fee
prev
next
( X )
CAD
Description
Credit Card
I have sent an e-transfer to mooselakegospelcamp@gmail.com for the Fee Due
*
yes
E - Transfer Reference Number (Write CC if payment was made with a credit card)
*
Submit
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