Senior High Camp Registration 2023 Step 1 of 4 - SELECT GENDER 0% SELECT GENDERGender* Boy Girl CAMPER INFORMATIONCamper Name* First Last Address* Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920School grade entering in fall* Cabin Mate RequestChoice 1 Choice 2 HEALTH INFORMATIONPhysician’s Name* Physician’s Phone Number* PARENT INFORMATIONParent Name* First Last Primary Phone*Secondary PhoneEmail* CHURCH INFORMATIONLocal Church Name* Pastor’s Name Church PhoneChurch mailing address*EMERGENCY CONTACT INFORMATIONEmergency Contact Name* First Last Phone Number*Relationship to Camper* PaySenior High Camp Fee Price: 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
