Elevate Summer Camp - Leader Registration 2023

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Please fill out information below. Registration closes at midnight of May 31st.

Which church do you attend? *

First Name *

Last Name *

Gender *

Female

Male

T-Shirt Size? *

Please select one.

Home Address *

Example: 123 Main St., Cityville, TX 77123

Mobile Phone # *

We will be contacting via text on camp updates. Your mobile provider's standard rates for text messages apply.

E-mail Address *

Date of Birth *

YYYY

1st Emergency Contact Name *

1st Emergency Contact Phone # *

Relationship to Leader *

2nd Emergency Contact Name *

2nd Emergency Contact Phone # *

Relationship to Leader *

Friday Breakfast Taco Order *

PLEASE SELECT UP TO 2 OPTIONS

Bacon & Egg

Potato & Egg

Bean & Cheese

2 of the selected above

Required

Do you have any food allergies or physical incompetencies? *

Yes

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