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Senior Week
Intermediate Week
Junior Week
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Online Registration 2023
*
Indicates required field
I need assistance paying for my week/weeks of camp:
*
Yes
No
Maybe
The cost for a week of camp is $125 per person. Please specify how much of the expense you can cover.
*
Please select which week(s) you plan to attend:
Note: We have consolidated the form this year to simplify the process. Please select all weeks you intend to attend as a camper and those you intend to attend as a staff member.
Weeks of Camp as Camper
*
Senior Week: July 2-7
Intermediate Week: July 9-14
Junior Week: July 16-21
All-Age Week: July 23-28
Singing Week: July 30-August 4
Weeks of Camp as Staff
*
Senior Week: July 2-7
Intermediate Week: July 9-14
Junior Week: July 16-21
All-Age Week: July 23-28
Singing Week: July 30-Aug 4
Full Name
*
First
Last
Gender
*
Male
Female
Age
*
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25-29
30-39
40-49
50-59
60-69
70-79
80-89
90-99
Last School Grade Attended
*
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College / Above High School
Church Affiliation
*
Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
E-Mail Address
*
Parent/Guardian Name
*
First
Last
This is required if you are not 18 years old at the time of registration.
Phone Number #1
*
Parent/Guardian E-Mail Address
*
Phone Number #2
*
Emergency Contact Name
*
First
Last
Relationship
*
Parent/Guardian
Spouse
Child
Grandparent
Aunt/Uncle
Sibling
Family Friend
Phone Number #1
*
Phone Number #2
*
The following individuals may pick me (registrant) up from camp:
(Staff Members - please list yourself.)
Name
*
First
Last
Name
*
First
Last
Phone Number
*
Phone Number
*
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
Other Medical Problems:
*
Any Known Allergies:
*
Medications: Please check medications the nurse can give you.
Check all that apply.
*
Tylenol
Ibuprofen
Aspirin
Aleve
Midol
Benadryl
Sinus Tablets
Tussin DM
Laxative
Pepto Bismol
Other
Other:
*
Please list any current medications and dosages for each.
Current Medications
*
Please list any current medical issues, disabilities, and/or chronic disease.
Medical Issues
*
Please list any dietary modifications.
Dietary Modifications
*
Please list any other information you need to share.
Other Information
*
Submit
Home
Events
Senior Week
Intermediate Week
Junior Week
All-Age Week
Singing Emphasis Week
Fall Camp
Spring Camp
About Us
Directions
Mailing Address
Contact Us
Camp Board
Online Store
Fundraisers
Bluegrass & BBQ
Golf Benefit