2024 Camper Application - Registration

Please enter information in the form below to register for 2024 Camper Application .

Applicant’s Full Name: *

Date of Birth *

Age (at camp) *

Name on name tag button if different from above (subject to approval)

Gender *

Address *

City *

State *

Zip *

Parent/Guardian Name *

Home Phone *

Cell Phone

Contact Email *

Camper Email (if any)

Youth Shirt Size *

Grade in Fall 2024 *

List ONE roommate preference in your grade level - use full name

Friend's Church

Amount

Payment Method *

Paypal Pay by Check

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*