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REGISTRATION FORM Youth Camp 2012 (Please print in ink) Camper’s Name _____________________________________________________________ Parents’ Names ______________________________________________________________ Address _______________________________________________________________________ City _____________________________ State _________ Zip ________________________ Phone ( ______ ) _______________ q Home q Cell Phone ( ______ ) _______________ q Home q Cell Family email address _______________________________________________________ Home Church ________________________________________________________________ q Male q Female Grade completed by June _____ Birth date ____ / ____ / ____ Age at camp time _____ I plan to attend: q Junior I Camp (completed grades 3 or 4) q Junior II Camp (completed grades 5 or 6) q Teen I Camp (completed grades 7–9) q Teen II Camp (completed grades 10–12) Please Note: The camp is determined by the grade completed by June. I have enclosed:
q Total Camp Fee (includes non-refundable deposit) q $150 Early Camp Fee (before April 1st) q $160 Total Camp Fee q $170 Late Camp Fee (after Monday before camp) OR q Non-refundable Deposit: $20 (balance due upon arrival at camp) q Family Discount (siblings registering at the same time) q Cabin mate Request _____________________________ (ONE REQUEST ONLY—your choice must request you.) q I am attending youth camp for the first time and was invited by: ________________________________________________________________________
Complete this registration form and mail with camp fee to: Patti Perry, Peniel Bible Camp Registrar |
