Elementary Camp Registration

Ministries : CYF Summer Faith and Fun : Elementary Camp : Elementary Camp Registration

Elementary Camp Registration, Grades 3-5: July 15 - 20, 2012

* Required

First and Last Name of person completing registration *

Email Address for confirmation of registration*

Camper's Name *

Address *

City, state, zip *

Home Phone *

Gender *
male
female

Age *

Grade completed in June 2012 *

Date of Birth *

Parent/Guardian #1 *

Parent/Guardian #1 Cell Phone *

Parent/Guardian #1 Email *

Parent/Guardian #2

Parent/Guardian #2 Cell Phone

Parent/Guardian #2 Email

Are you interested in fundraising? *
Yes
No

Our child has permission to take part in all camp activities under supervision, and we agree that the camp or its personnel will not be held responsible for accidents arising therefrom. I give permission to transport my child or family for camp programs and emergencies. I also give permission for the use of photographs, video, and electronic images including my child or family in camp promotions. *
Agree
Disagree

Registration and payment must both be received for this registration to be complete. Scholarships are available - please contact Pastor Todd at todd@lordoflife.org. You will be brought to the e-pay page after you click submit. You may choose to pay the $125 non-refundable deposit, $389 total amount or $364 total amount with multi-camper discount (if sending more than one camper to Half-Pint and/or Elementary camps).