Camper Information

Camper's Name

Date of Birth

Gender

Grade entering in Fall 2024:

Phone Number

Church Attending:

Camper Lives with:

Address

Who will be picking up your child at the end of camp?

Campers in grades K-8th grades must be signed out by an authorized adult at the end of the week.

Name

Relationship to Camper

If there are any persons NOT ALLOWED to pick up OR visit your child, please list name(s) and relationship(s).

When and where appropriate, please type "N/A" (not applicable) in appropriate box and use zeros for that phone number. Thank you!

Mother's Name

Mother's Phone Number

Father's Name

Father's Phone Number

Legal Guardian's Name [leave blank if same as parent]

Legal Guardian's Phone Number (leave blank if same as parent)

Address