Camper Registration
:
Name:
  First Middle Last
Name Preference: Please enter the name your child prefers to be called.
 
Address:
 
  City State Zip
Birthdate: //
Gender:
Grade: Select the grade you will be entering this fall
School:
Church:
E-Mail:
Swimming: Camper has permission to swim? (Yes or No)
Medical Information
History:
Allergies:
Medications:
Tetanus:
Insurance:
Policy Number:
Parent Information
Name:
Home Phone:
Employeer:
Work Phone:
Cell Phone:
E-Mail:
Mini camp: Are you attending Mini Camp with your child?
Second Parent Information
Name:
Home Phone:
Employeer:
Work Phone:
Cell Phone:
E-Mail:
Mini camp: Are you attending Mini Camp with your child?
 

Mini Camp

Starts In

13

Days




Full Camp

Starts In

15

Days