|
REGISTRATION FORM Family Camp 2012 (Please print in ink) Father’s Name _______________________________________________________________ Mother’s Name ______________________________________________________________ Address _______________________________________________________________________ City _____________________________ State _________ Zip ________________________ Phone ( ______ ) _______________ q Home q Cell q Work Phone ( ______ ) _______________ q Home q Cell q Work 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 2–7 (Late after June 25) q August 6–11 (Late after July 30) 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, Peniel Bible Camp Registrar |
