Camper Registration Form
Please Print (One Camper per form)
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Sex:
M
F
Check Weeks that Apply
Adventure June 21 - 26
Day Camp June 22 - 26
Basics I June 28 - - July 3
Basics II July 5 - - 10
Address
Age
T-Shirt Sizes
Youth:
S
M
L
Adult:
S
M
L
XL
XXL
XXXL
City
State
Zip
Parent or Guardian
Email
example@example.com
Home Phone
Format: (000) 000-0000.
Work/Cell
Format: (000) 000-0000.
Roommate Request (limit One Please)
Does your child have any food allergies?
Yes
No
To ensure your child's place at Camp, please send registration with a $25 non-refundable deposit. (Balance due upon arrival) Save $10 with the Early Bird Discount on overnight camp only, when full payment is received by June 1st.
OFFICE USE ONLY
RD
Dis
#
Amt
Bal. Due
Grass Roots Ministries, Inc.
10055 Camp Road NW
Beach City, OH 44608
Return Service
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