Summer Camp - Registration

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Summer Camp Online Registration

[Camper Information]

Registration Type:

Group

Individual

Congregation:

Cong. City:

Camper Name:

Address:

City:

State/Zip:

Sex:

Date Birth:

Grade Completed:

Parent/Guardian:

Home Phone:

Work Phone:

Family Email:

[Program Options]

Site

Program

Dates

1st Choice:

2nd Choice:

Discounts

[Sibling Discount]

Name of Siblings:

(if applicable)

[Multiple Program Discount]

Other Programs:

(if applicable)

Does the camper have any special need? Explain:
Housing Mate Preference (one name only)

[Payment Information]

If you are submitting a group registration, payment will be handled later.

Card Type:

Mastercard

Visa

Discover

Card Number:

Exp Date:

3 digit code:

Amount ($):

You may pay for the entire program or pay $85
deposit with balance due 4 weeks before camp date

Check this box if you agree to the following disclaimer:
I will not hold Cross Trails Ministry or its staff responsible for accidents, claims and damages arising from my or my child's participation in camp activities. I also give Cross Trails Ministry permission to use any photograph/video of me or my child, taken at camp, in future promotional materials for its sites and programs.