Camper Registration Form: Week 2: Intermediate
Camping Dates: July 2nd - 7th - Ages 12 to 13

All camps begin on Sunday at 3pm and end on Friday at 12pm.
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Camper Information
Camper's Last Name *
Camper's First Name *
Camper's Preferred Name
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address *
Name of school and grade
Faith (if applicable - for statistical use only)
Doctor's Name
Doctor's Phone Number
MCP Number *
Legal Custody *
Required
Cabinmate Request #1
This is not a guarantee that two campers will be in the same room.
Cabinmate Request #2
This is not a guarantee that two campers will be in the same room
T-Shirt Size - These are adult sizes. Registrations submitted after June 1st are not guaranteed their chosen size. *
Photo Consent *
Your child may photographed or videoed at camp. Please indicate if photos or videos of your child may be used for program or promotion of the camp. Each child will be sent home with a camp photo from their week.
Please indicate and give details in the field below if your child has any special dietary concerns.
Other information
Please provide any other information you feel is necessary for the counselors of the camp to be made aware of in the space below.
Parent/Guardian #1 Information
Parent/Guardian #1 Name *
Home Phone *
Cell Phone
Work Phone
Address if different from camper
Email Address *
Email is used for most of our correspondence
Parent/Guardian #2 Information
Parent/Guardian #2 Name
Home Phone
Cell Phone
Work Phone
Address if different from camper
Email Address
Email is used for most of our correspondence
Alternate Emergency Contact
Please provide contact information for someone in the event that the Parent/Guardians listed previously are unavailable.
Name *
Contact Number *
Other Phone
Relationship to camper
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