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Please print this web page, complete the entries, and mail the completed
form along with your payment to the address above.
Registration 2007
Summer Youth Program
(Please use
separate form for each camper)
Name
__________________________________________________________ Phone
_________________________________
Mailing Address
________________________________________________________________________________________
_______________________________________________________________ Zip
___________________________________
Gender ________________
Birth Date _____________________________ Grade Finished as of June 2006
_________________
_______ Girls Week July
23-28 Ages 9-12
_______ Young Women's Week July 20-28 Ages 13-18
_______ Boys Week June
25-30 Ages 9-12
_______ Young Men's Week June 25-30 Ages 13-18
Campers must stay for
closing program.
Cabin Mates
Request (Please
do not request cabins or counselors): _____________________
_____________________________________________________________________________________________________
Health & Accident
Insurance no longer available.
Please enclose
$95 registration fee for summer programs. The suggested additional fee
is due upon arrival
at camp.
SPECIAL NOTE: Our main purpose
for these weeks is to assist the parents in building character
qualities into their children. Please list here one or
more character qualities which you would like to see
strengthened in your child.
(See Gal. 5:22 & Matt. 5:3, 12)
_________________________________________________________________________________
*Health history
required, physical requirement waived. In case of medical emergency;
I
hereby give my full consent to the physician selected by the camp
director to hospitalize and secure proper treatment for my child as
named above. Please see liability release
Parents/Guardians
Signature (Full Name)
_____________________________________________________________________
(Both Parents sign)
_____________________________________________________________________________________
If you have no phone,
how can we locate you in case of emergency?
_______________________________________________
____________________________________________________________________________________________________
If you are coming with a
brother/sister do you want to be in the same cabin?
_________________________________________
Confirmation will be sent
within 4 weeks after we receive your form.
*Included with
confirmation. (See Financial Policy) |
