2008 Summer Online Registration Form (all areas with * are required) Type in
* Full Name of Camper
* Preferred Name
* Gender
* Date of Birth
* Grade Entering in Fall of 2008
Camper's Email Address
* Church and City of Church/Denomination
* Session Information
select one
Senior High A June 7-13 Ages 15-graduation
Primary Camp A for boys only June 15-21 ages 8 1/2 -10 as of Sept 1 2008
Junior High A June for boys only 24-30 ages 13-14 as of Sept 1 2008
Intermediate Camp A July 2-8 Ages 11-12 as of Sept 1 2008
Senior High B July 14-20 ages 15-graduation
Primary Camp B July 22-28 ages 8 1/2 -10 as of Sept 1 2008
Junior High Camp B July 31-Aug 6 ages 13-14 as of Sept 1 2008
Intermediate Camp B Aug 8-14 ages 11-12 as of Sept 1 2008
Senior High Trip Camp July 1-8 Ages 15-graduation
Primary Camp A Girls Waiting List
Junior High Camp A Girls Waiting List
* Home Address
* City
* State
* Zipcode
* Home Phone (333-333-3333)
* Best Email Address (will receive confirmation)
* Mom/Guardian
Mom Cell Phone (333-333-3333)
Mom Work Phone (333-333-3333)
* Mom Email Address
* Dad/Guardian
Dad Cell Phone (333-333-3333)
Dad Work Phone (333-333-3333)
* Dad Email Address
* If parent is not available in an emergency, notify
* Emergency Contact Relationship
* Emergency Contact Home Phone (333-333-3333)
* Emergency Contact Cell Phone (333-333-3333)
* Emergency Contact Work Phone (333-333-3333)
* Payment of $330 for Primary, Intermediate, or Junior High Camps (full amt must be paid)
NO
YES
* Payment of $350 for Senior High Camp (full amt must be paid)
NO
YES
* Payment of $425 for Senior High Trip Camp (full amt must be paid)
NO
YES
* Credit Card Information
select one
MSTR
Visa
Discover
AMEX
* Full name on Credit Card
* Credit Card Number (please put the spaces in)
* Expiration Date of Credit Card (03/13)
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