Virtual Mount Hermon Registration - Junior High Camp 2021

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Email *

Student's First Name *

Student's Last Name *

Gender *

Female

Male

Grade in FALL 2021 (the grade they enter next school year) *

6th Grade

7th Grade

Date of Birth (xx/xx/xxxx) *

Address (Street) Example: 1234 Flower Ave. *

Address (City) Example: Garden Grove *

Address (State) Example: CA *

Address (Zip Code) Example: 92845 *

Parent Phone #. Example 123-456-7890 *

Student Phone # (if it's okay for cabin leader to contact/text student directly)

Parent/Guardian Email (You can list more than 1 if you'd like multiple people to see camp emails/updates) *

Student Email (if it's okay for cabin leaders to contact student directly)

Do you currently attend a church? If yes, what church.

Does your student have any food allergies? If yes, please list all food allergies:

Did your student attend Mount Hermon Jr. High Camp last Summer?

Yes

Clear selection

If this is your first time participating at Jr High Camp, does your student have a small group buddy request? Please list them below ( If this is not your student's first time, you can still make a small group buddy request. We will do our best to pair students with a buddy- if we can)

What is the best method of getting your student's supply box to them?

I will come pick it up or a friend will pick it up for me (pending the pick up day/location)

I would prefer to have it mailed

I live in NorCal or out of state (it will automatically be mailed).

Clear selection

Are there any days you forsee your camper needing to miss camp? (you can email camp director if your schedule changes between now & camp)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Is there anything you'd like us to know about your student? (mental, emotional or social health. Ie. if the camper has had a significant life event happen that still is impacting them, if the camper has been diagnosed with ADD or ADHD, etc) Please know this information is kept confidential with our staff, and can help us to better love & minister to your student during camp.

Is the student registered to attend Main Camp with their family? *

Yes

We're still deciding if we're going to go to Main Camp

If this is your first time participating in a JEMS Mount Hermon Youth Camp, please share how you heard about it (list a person or church, or social media posting that provided the registration link):

Any additional comments/questions?

A copy of your responses will be emailed to the address you provided.

Submit

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