FJA Camp Registration Form

FJA Camp Registration Form

This application is for campers aged 15-35, and each church group is required to provide one chaperone for boys and one for girls. Please note that accommodations are in shared spaces, and you may be asked to share a bed at the hotel lodge. APPLICATIONS WILL BE ACCEPTED BY ONLINE FORM & BY MAIL TO THE US Postal Service To: P.O. BOX 11575 Glendale CA, 91226 Church Checks or Money Orders MUST be paid to the order of “FJA of SCC” NO PERSONAL CHECKS. NO CASH. NO REFUNDS. APPLICATIONS ARE NON-TRANSFERABLE. NO EXCEPTIONS.
FJA CAMP April 25th, 26th, 27th

Location: 39850 CA-38, Angelus Oaks, CA 92305 // Phone: (909) 794-2911
Pacific Union Conference: Which Conference are you from?*

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*
Baptized*
Church Name*
AY Director *

First NameLast NameAge
AY Director Mobile Number*
Pastor of Local Church*
1st Elder of Local Church*
Pastor Signature*

Powered by Jotform SignClear
1st Elder Signature

Powered by Jotform SignClear
I am the Chaperone (I Understand I will stay with the campers I am assigned to at all times)

YesNo
Male Chaperone Name (Must stay with the campers they are assigned to at all times)*

First NameLast NameAge
Chaperone for

Male CabinMale Hotel
Mobile Number
Female Chaperone Name (Must stay with the campers they are assigned to at all times)*

First NameLast NameAge
Chaperone for

Female CabinFemale Hotel
Mobile Number

Emergency Contact:*

	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*
Accommodations: Date of submission will determine Early or Late fee*

Early Bird Cabin ($140) Date: 3/7/2025 - 4/5/2025Early Bird Hotel ($200) Date: 3/7/2025 - 4/5/2025Regular Cabin ($180) Date: 4/6/2025 - 4/19/2025Regular Hotel ($260) Date: 4/6/2025 - 4/19/2025Late Fee Cabin ($290) Date: 4/20/2025 - 4/24/2025Late Fee Hotel ($320) Date: 4/20/2025 - 4/24/2025Walk in Cabin ($450) Date: 4/25/2025Walk in Hotel ($450)Date: 4/25/2025Day Pass ($110) 4/26, 4/27 Time: 6AM - 5PM
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)

Powered by Jotform SignClear
Should be Empty:

FJA Camp Registration Form

FJA CAMP April 25th, 26th, 27th