Name * First Name Last Name Email * What Email will be used when submitting your Participation Fee? * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Gender * Male Female T-Shirt Size X-Small Small Medium Large X-Large XX-Large XXX-Large Marital Status * Languages Spoken * Medical Conditions * Allergy information, dietary restrictions, etc. Church Membership * Reference * Are you are part of a group? * If you are, please name the leader. Other information Anything we need to know about you Would you like to have any music participation? This refers to having special music. Can include singing or playing an instrument (you will have to bring your own). Breakouts Friday and Sunday Breakouts * Woodwork Crocheting Welding **LIMITED SPACE** Sabbath Breakout * Country Living Spiritual Growth Dating and Relationships Emergency Contact Name of Emergency Contact * First Name Last Name Phone of Emergency Contact * Country (###) ### #### Email of Emergency Contact * Address of Emergency Contact * Address 1 Address 2 City State/Province Zip/Postal Code Country Agreement Agreement and Signature * By submitting this online application, I affirm that the facts set forth in it are true and complete. I understand that if I am found to have made any false statements, omissions, or other misrepresentations on this application, this may result in my immediate dismissal. By typing my full name in the field below, I am electronically signing my name. Date * MM DD YYYY Thank you! You will be sent a confirmation e-mail once we receive both your Registration Form and Participation Fee. 2023 Summer Camp Registration Form
