Summer Camp Registration

Summer Camp Registration

Summer Camp Registration
Campers Name: *

First
Last
Camper's Gender *
Camper's Birthday: *

DD 		/
MM 		/
YYYY
Please enter your camper's birthday.
Last Grade Completed: *
Please select the last grade your camper completed.
Home Address: *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
What church do you attend?
If you attend a church please let us know.

Parent/Guardian #1 Information:

Please fill out of the following form.
Parent/Guardian #1: *

First
Last
Home Address (If Different):

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Only fill in if your address if different than your camper.
Work Address:

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Please give us your work address in case of emergency.
Home Phone Number: *

### 		-
### 		-
####
Work Phone Number:

### 		-
### 		-
####
Cell Phone Number

### 		-
### 		-
####
Email *
Please fill out your email address so we can contact you in the future.
Confirm Email *

Parent/Guardian #2 Information:

Please fill out the following information.
Parent/Guardian #2:

First
Last
Home Address (If Different):

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Only fill in if your address if different than your camper.
Work Address:

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Please give us your work address in case of emergency.
Home Phone Number:

### 		-
### 		-
####
Work Phone Number:

### 		-
### 		-
####
Cell Phone Number

### 		-
### 		-
####
Email
Please fill out your email address so we can contact you in the future.
Confirm Email

Authorized Pickup Of Child:

Please let us know who is authorized or NOT to pickup your child.
Person(s) other than parent/guardian authorized to pick up child from Golden Bell Camp: *
Person(s) other than parent/guardian NOT authorized to pick up child from Golden Bell Camp:

Camp Registration:

Information on which camp you will be attending at Golden Bell
Which camp will you be attending? *
Horseback Riding ($32)?
 Horseback Riding 
Only available for selected camps: Explorers, Pathfinders, Itch-ee-ow-ee, Mini-Itchee, Itch-ee-ow-ee Adventure, and Velocity.
Whitewater Rafting ($32)?
 Whitewater Rafting 
Only available for Velocity camp.
Shirt Size (Included in Price): *
 Youth Small 
 Youth Medium 
 Youth Large 
 Adult Small 
 Adult Medium 
 Adult Large 
 Adult XL 
Please choose one size for your camper.
Camp Media Options?
 Camp Photo ($8) 
 Camp DVD ($15) 
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