Camper Registration Form Please Print (One Camper per form)
Check Weeks that Apply
Check Weeks that Apply
Adventure June 21 - 26
Day Camp June 22 - 26
Basics I June 28 - July 3
Basics Il July 5 - - 10
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Sex:
M
F
Address
Age
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.
Camp Buckeye Grass Roots Ministries, Inc. 10055 Camp Road NW Beach City, OH 44608
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