|
REGISTRATION FORM Family Camp 2010 (Please print in ink) Father’s Name ______________________________________________ Mother’s Name _____________________________________________ Address ____________________________________________________ City _______________________ State _______ Zip _______________ Phone ( ______ ) _______________ q Home q Cell qWork Phone ( ______ ) _______________ q Home q Cell qWork Email address _______________________________________________ Home Church _______________________________________________ Child’s Name ______________________ Age/Grade completed _____ / _____ Child’s Name ______________________ Age/Grade completed _____ / _____ Child’s Name ______________________ Age/Grade completed _____ / _____ Child’s Name ______________________ Age/Grade completed _____ / _____ Child’s Name ______________________ Age/Grade completed _____ / _____ Child’s Name ______________________ Age/Grade completed _____ / _____ We plan to attend: q July 5–10 (Late after June 28) q August 9–14 (Late after August 2) We request the following accommodations: (subject to availability) q Cabin ___ large family cabin ___ small lakefront cabin (family of 4 or fewer) q Campsite for tent or trailer (electric & water available) q Drive-in (contact Registrar for camp fees) We have enclosed: q $50.00 deposit (applied to total camp fee) q Total Camp Fee of $_________________ (total includes $50 deposit)
Complete the registration form and mail with camp fee to: Patti Perry, Camp Peniel Registrar
(Address until 6/24) 103 Parkview Ave Westerville OH 43081
(Address after 6/24) 3260 State Route 314 Fredericktown, OH 43019
|