Camper Information

Camper's Name

Date of Birth

Gender

Male
Female

Grade entering in Fall 2024:

Phone Number

Church Attending:

Camper Lives with:

Address

If there are any persons NOT ALLOWED to pick up your child, please list name(s) and relationship(s). Campers in grades K-8th grades must be signed out by an authorized adult at the end of the week.

Guardian Information

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

Event Registration Software by RegFox

Senior High 2 [9th - 12th]

Camper Information

Guardian Information