Event Attending: 
                    Day Camp
                    First Chance
                    Middlers I
                    Middlers II
                    Intermediate I
                    Intermediate II
                    Junior High I
                    Junior High II
                    High School
                    Deeper Life
                    Sr Hi Retreat
                    Max X
                    
                    Date of the Event: 
                    Bunk Preference: 
                    Upper
                    Lower
                    
                    Cabin Partner: 
                    Name: 
                    Address: 
                    City: 
                    State: 
                    Zip: 
                    Email: 
                    Gender: 
                    Male
                    Female
                    
                    Grade this fall: 
                    K
                    1
                    2
                    3
                    4
                    5
                    6
                    7
                    8
                    9
                    10
                    11
                    12
                    
                    Age: 
                    5
                    6
                    7
                    8
                    9
                    10
                    11
                    12
                    13
                    14
                    15
                    16
                    17
                    18
                    
                    Immersed Believer: 
                    Yes
                    No
                    
                    Day Phone:  Night:  Cell: 
                    Parent Name: 
                    Home Church: 
                    Sponsoring Church (if any): 
                    Sponsoring Church will pay this amount: 

                    I agree to pay the registration fee on Registraton Day.
                    Signature: