COGOP Mid-Atlantic Regional Camping Ministry

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Camper's Name:

Camper's Date of Birth

YYYY

Parent(s)/ Guardian(s) Name:

Parent(s)/ Guardian(s) Home Phone:

Parent(s)/ Guardian(s) or Camper's (Young Adult) Email:

Street Address:

Church Name:

Pastor's Name:

Church Address:

Camp Attending

Young Adult

Youth

Junior

Peewee

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Name of Emergency Contact:

Emergency Contact Phone Number:

Relationship to Camper:

A copy of your Health Insurance Coverage/Updated Medical Form will need to be provided. Anyone not having verifiable health insurance coverage will be required to take the health insurance coverage through Brotherhood Mutual Camp Insurance Policy that will be sent to each approved applicant. Please complete the digital medical form at https://form.jotform.com/240127940728154.

Camp Price

$225

Please make all payments on Cash App to $macogop302 and add your child's/children’s name to the comments section with the words SUMMER CAMP

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