Winter Kid's Camp Registration 2024

Camper First Name *

Camper Last Name *

Address *

Address 2

City *

State/Province *

Zip/Postal Code *

Parent/Guardian(s) First Name: *

Parent/Guardian(s) Last Name: *

Parent or Guardian Email *

Parent/Guardian(s) Phone *

Emergency Contact (other then Guardian) First Name: *

Emergency Contact Last Name *

Emergency Contact Phone *

Church or Youth Group

Gender *

Female

Male

Camper's School Grade *

Cabin Buddy Request

Any Allergies or Medication (Enter none if needed) *

Anything you would like us to know about camper?

Legal Guardian Signature *

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