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REGISTRATION FORM Youth Camp 2010 (Please print in ink)
Camper’s Name __________________________________________ Address ________________________________________________ City ______________________ State _______ Zip ____________ Parents’ Names __________________________________________ Phone ( _______ ) _______________ q Home q Cell Phone ( _______ ) _______________ q Home q Cell Parents’ email address _____________________________________ Home Church ___________________________________________ Church I am coming with (if different) _______________________
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, Camp Peniel Registrar
(Address until 6/24) 103 Parkview Ave Westerville OH 43081
(Address after 6/24) 3260 State Route 314 Fredericktown, OH 43019 |