KIDS CAMP REGISTRATION FORM

Grades 3-5 July 18-22

Registration Deadline: July 4th Early Bird Deadline: June 20th

Please Note: Only the first 500 registered for each camp will be accepted!

Registration Fee:

$215 (one child)

Early Bird Special:

$199 (one child) Registrations must be received by the Early Bird deadline.

After Registration Deadline:

$230 per camper

Camp T-Shirt:

T-Shirt Size:

(now included with price of registration)

Camp DVD:

$15 DVD Yes No

All Fees are non-refundable, but are transferable only within 2011 Kids/Youth Camps.

CAMPER INFORMATION

Name:

Last

First

Middle

Gender:

Age:

Grade: (Fall 2011)

Parent/Guardian Name:

Last

First

Middle

Street Address:

City:

State

Zip

Home Phone: (

) - -

Cell Phone: (

) - -

Alternate Number: (

) - -

Local Church:

Street Address:

City:

State

Zip

Sr. Pastor:

Pastor's Email:

If unknown type: unknown@unknown.com

I would like to room with:

Student's Email:

Please retype the student's Email address:

Parent's Email:

Please retype the parent's Email address:

I wish to recieve emails regarding changes to camp:

sent to parents email address

I wish to recieve emails regarding other Ohio Ministry Network promotions or events:

sent to parents email address