Pre-Teen Camp 2023

July17-21, 2023 | Pre-Teen Camp 2023 is July 17-21. This camp is for students who have completed 3rd grade through 5th grade. Full camp cost is $250.00. Deposit of $125.00 may be made at your convenience with the full amount of $250 due by June 23, 2023. (Scholarships may be available, contact Dave Benefield.)

Name

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Parent/ Guardian Name

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Address

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Primary Phone

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Other Phone

Email

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This address will receive a confirmation email

Gender

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Please select all that apply.

Male Female

Birthday

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Grade Completed End of Spring 2023

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Allergies, Medical, & Special Needs

Emergency Contact Name #1

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Emergency Contact Phone #1

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Emergency Contact Name #2

Emergency Contact Phone #2

Authorized Pick- Up #1

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Authorized Pick- Up #2

Authorized Pick- Up #3

Authorized Pick- Up #4

Are you a member of this church?

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Please select all that apply.

Yes No

Guest Of:

Do you attend Church?

Please select all that apply.

Yes No

If so, where?

May we have permission to photograph your child?

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Please select all that apply.

Yes No

May we have permission to use your child's photograph in church publication?

*

Please select all that apply.

Yes No

Select T-Shirt Size

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Please select all that apply.

Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL

Payment

Deposit ($125.00) Full Amount ($250.00) Pay in Office (0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

July17-21, 2023

Pre-Teen Camp 2023 is July 17-21. This camp is for students who have completed 3rd grade through 5th grade. Full camp cost is $250.00. Deposit of $125.00 may be made at your convenience with the full amount of $250 due by June 23, 2023. (Scholarships may be available, contact Dave Benefield.)

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