Clone of FJA Camp Registration Form

FJA Camp Registration Form

This application is intended for campers between 15 and 35 years old. Each church group must designate one chaperone for male participants and another for female participants. Please note that accommodations will be in shared spaces and that, in some cases, it may be necessary to share a bed at the hotel.
IMPORTANT

APPLICATIONS WILL BE ACCEPTED BY ONLINE FORM ONLY. Please mail all Church Checks or Money Orders To: P.O. BOX 11575 Glendale CA, 91226 (Church Checks MUST be paid to the order of “FJA of SCC” NO PERSONAL CHECKS. NO CASH. NO REFUNDS. APPLICATIONS ARE NON-TRANSFERABLE. NO EXCEPTIONS.) If you would like to deliver the check personally please coordinate with Christina or Rachel
FJA CAMP April 24th, 25th, 26th

Location: 39850 CA-38, Angelus Oaks, CA 92305 // Phone: (909) 794-2911
SOUTHERN CALIFORNIA CONFERENCESOUTH EASTERN CALIFORNIA CONFERENCENORTHERN CALIFORNIA CONFERENCECENTRAL CALIFORNIA CONFERENCEOther
Full Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
Baptized*
Church Name*
AY Director *

First NameLast NameAge
AY Director Mobile Number*
Format: (000) 000-0000.
Pastor of Local Church*
1st Elder of Local Church*
Pastor Signature*
1st Elder Signature
YesNo
Male Chaperone Name (Must stay with the campers they are assigned to at all times)*

First NameLast NameAge
Male CabinMale Hotel
Mobile Number
Format: (000) 000-0000.
Female Chaperone Name (Must stay with the campers they are assigned to at all times)*

First NameLast NameAge
Female CabinFemale Hotel
Mobile Number
Format: (000) 000-0000.

Emergency Contact:*

Rows	Name	Relationship	Phone Number
Person #1
Person #2

Medical Information: If any medical conditions such as: diabetes, high blood pressure, recent surgery, organ transplant, asthma, heart problems, epilepsy, etc. and/or any allergies (if severe, please be sure to bring an EpiPen & or any prescribed medications), please list below:
Dietary Preferences*
Early Bird Cabin ($165) Date: 2/22/2026 - 3/20/2026Early Bird Hotel ($220) Date: 2/22/2026 - 3/20/2026Regular Cabin ($200) Date: 3/21/2026 - 4/4/2026Regular Hotel ($290) Date: 3/21/2026 - 4/4/2026Late Fee Cabin ($290) Date: 4/5/2026 - 4/18/2026Late Fee Hotel ($320) Date: 4/5/2026 - 4/18/2026Walk in Cabin ($450) Date: 4/19/2025Walk in Hotel ($450)Date: 4/19/2025
My Products
prevnext( X )
Product Name
Enter description

$10.00 Quantity

Total

$0.00
Tshirt size: EARLY BIRD ONLY!!!!!
Liability: I understand that photography and video may occur during the event. I consent (*for my child) to such recording media and its release for promotional purposes by FJA. Campers with any medical conditions are responsible for bringing their medication. FJA is not responsible for any medication forgotten by the camper. I authorize (*my son/daughter) to be treated in case of a medical emergency. I also understand that I am responsible for any consequences due to actions or conduct that may be detrimental to this event. I certify that I am at least 18 years of age or that I am the camper’s parent/guardian. I have read the regulations and rules for camp.*

YesNo
Camper's Signature (Parents / Guardians Signature if Camers is 15 -17 yr of age)
Should be Empty:

FJA Camp Registration Form

IMPORTANT

FJA CAMP April 24th, 25th, 26th