Register Online

Please fill out this simple form and click "Send Registration"

Please fill out this form COMPLETELY. Payment options are displayed below.

Select Session:	Servant Week (June 1-7)
Session is Full	Day Camp (June 9-14)
Session is Full	Mars Hill (June 15-21)
	Junior Week (June 22-28)
	Music Week: (July 6-12)
	Living Stones Week (July 13-19)
	Teen week (July 20-26)

Camper's Name:
Gender:	Boy / Girl
Next School Grade:
Birthdate:*	(mm/dd/yyyy)
T-Shirt Size:

* October 1 is the date used for admittance (must be 10 by Oct 1)

Parent's Name(s):
Contact Phone:
Address:
Parent's email address
City:
State:	Zip:

Church Preference:
Are you a Member?	Yes / No
Home Congregation:
Address:

City:
State:	Zip:

In case of emergency, we need to know your social security number:

Allergies or other pertinent information we should know about:

Family Health Insurance Carrier:
Insurance No.:

Payment Method:

	Check or Money Order
	Credit Card (Call In)
	Requesting "Campership"