* Group Leader Name

* Church you are registering for

Number of Students You Are Registering
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Please list counselors you are sending and which camps they are attending. Be sure to send Counselor Apps & Pastor Recommend forms for each counselor (or fill out online)

Select your payment option: (Remember, check must be received by May 11 deadline to get pre-reg. price)
I am paying by credit card (fill in info below) I am paying by check (registrations are INVALID until check is received)

City

State

Zip

Phone (xxx-xxx-xxxx)

Special Notes/Comments

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