Primary Camp Registration

July 3 – 6, 2021

Campers entering grades 4 & 5

Arrival time: Saturday, 1:00 – 2:30 pm

Departure time: Tuesday, 6:00 – 7:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Primary Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Beginner Camp Registration

July 7 – 10, 2021

Campers entering grades 3 & 4

Arrival time: Wednesday, 3:00 – 4:30 pm

Departure time: Saturday, 1:00 – 2:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Beginner Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Senior High Camp Registration

June 12 – 15, 2021

Campers entering grades 10, 11, 12 & Graduating Seniors

Arrival time: Saturday, 1:00 – 2:30 pm

Departure time: Tuesday, 6:00 – 7:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Senior High Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Junior High Camp Registration

June 19 – 22, 2021

Campers entering grades 8 & 9

Arrival time: Saturday, 1:00 – 2:30 pm

Departure time: Tuesday, 6:00 – 7:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Junior High Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Intermediate Camp

June 26 – 29, 2021

Campers entering grades 6 & 7

Arrival time: Saturday, 1:00 – 2:30 pm

Departure time: Tuesday, 6:00 – 7:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Intermediate Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Registration

Senior High Camp

June 12 – 15, 2021

Junior High Camp

June 19 – 22, 2021

Intermediate Camp

June 26 – 29, 2021

Primary Camp

July 3 – 6, 2021

Beginner Camp

July 7 – 10, 2021

SELECT GENDER

CAMPER INFORMATION

HEALTH INFORMATION

PARENT INFORMATION

CHURCH INFORMATION

EMERGENCY CONTACT INFORMATION

Pay

SELECT GENDER

CAMPER INFORMATION

HEALTH INFORMATION

PARENT INFORMATION

CHURCH INFORMATION

EMERGENCY CONTACT INFORMATION

Pay

SELECT GENDER

CAMPER INFORMATION

HEALTH INFORMATION

PARENT INFORMATION

CHURCH INFORMATION

EMERGENCY CONTACT INFORMATION

Pay

SELECT GENDER

CAMPER INFORMATION

HEALTH INFORMATION

PARENT INFORMATION

CHURCH INFORMATION

EMERGENCY CONTACT INFORMATION

Pay

SELECT GENDER

CAMPER INFORMATION

HEALTH INFORMATION

PARENT INFORMATION

CHURCH INFORMATION

EMERGENCY CONTACT INFORMATION

Pay