* First Name

* Last Name

Sex
M F

* Street Address

* City

* State

Zip Code

* Home Phone Number (xxx-xxx-xxxx)

* Parent's Work/Cell Number (xxx-xxx-xxxx)

Email Address (You must list an email address to receive a confirmation email)

Roommate Request #1

Roommate Request #2

Roommate Request #3

Please select your T-Shirt Size from the drop down menu
Small Medium Large XL 2XL

* Your home church

Church you are attending with (leave blank if same as above)

Please select which camp the teen will attend:
Middle School Camp (Will have completed grades 5-7) High School Camp (Will have completed grades 8-12)

Please select your student's camp cost option:
Regular student - $310.00 (before May 12) Regular student late - $350.00 (after May 12)

I would like to pay this much today: ($50 minimum deposit)

Select "Yes" if you are a Youth Sponsor/Leader/Pastor registering a group and will fill out a Group Registration Form with payment information (Leave below info for each registrant blank)
Yes No

City

State

Zip

Phone (xxx-xxx-xxxx)

Special Notes/Comments

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