Junior High Camp Registration

Junior High Camp Registration

Western Buckeye Camp Registration
Junior High Camp

June 14 - 19 / 7th - 9th Grades
Email*
Parent/ Guardian Email address
- Camper's Name*
  
  First NameLast Name
- MaleFemale
- Grade entering this fall
- Address*
- City*
- State*
- Zip Code*
- Parent/ Guardian Name(s)*
- Church Name*
- Church Town
- Camper Pick Up Person*
  If you're unsure, put anyone that could pick up
- Home Phone Number*
- Emergency Contact Name*
- Emergency Contact Phone Number*
- Physical Limitations*
- Allergies*
- Food Allergies*
  If your camper has a food allergy, please bring some food to store with campers name just in case.
- Prescriptions *
- Date of Last Tetanus Shot
- YesNo
- Insurance Company*
- Policy Holder*
- Group/ Policy Number*
- City*
- State*
- YesNo
- YesNo
- YesNo
- Person completing form*

My Products

Junior High Full Price

$78 is non-refundable

$284.00

Junior High Half Price

Remainder due by Registration, $78 is non-refundable

$142.00

Junior High Registration Fee

Remainder due by Registration, non-refundable

$78.00

Enter coupon

Total

$0.00

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