2022 Camper Card

Camper Registration

Please complete the form below to register for your preferred week(s) of camp.

Please select which week(s) you plan to attend:

Weeks of Camp *

Senior Week: July 3 - 8 Intermediate Week: July 10 - 15 Junior Week: July 17 - 22 All-Age Week: July 24 - 29 Singing Week: July 31 - August 5

* Indicates required field

Camper Name *

First

Last

Gender *

Male Female

Age *

Last School Grade Attended *

Church Affiliation *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number #1 *

Phone Number #2 *

Parent/Guardian E-Mail Address *

Camper E-Mail Address *

Emergency Contact Name *

First

Last

Relationship to Camper *

Phone Number #1 *

Phone Number #2 *

The following individuals may pick up my child from camp:

Name *

First

Last

Name *

First

Last

Phone Number *

Family Medical Insurance

Name of Insurance *

Policy Number *

Doctor's Name *

Phone Number *

Medical History

Please check all that apply. *

Frequent Ear Infections Asthma Seasonal Allergies Poison Ivy Diabetes Convulsions/Seizures Heart Ailments/Disease None