2022 Leader Registration Form

* Indicates required field

Leader's Name *

Camp Nick Name (each leader and leader in training picks a cute nick name example: care bear :)) *

Age: *

Sex: *

Male Female

Date of Birth (DD/MM/YYYY): *

Address: *

City: *

Postal Code: *

Home Phone *

Work Phone: *

Cell Phone: *

Email *

T-shirt Size (We may need this if we decide to purchase camp t-shirts) *

Who is Jesus to you? *

Why do you want to be a leader at camp? *

If you are under 18 years old a parent/guardian must fill our the remainder of the form. If you are a legal adult, YOU will need to fill out the remainder of the boxes, but you can skip parent/guardian's name and contact number.

Parent/Guardian Name (first/last): *

First

Last

Best Contact Phone Number: *

Medical Information

Allergies: *

Emergency Contact: *

Emergency Contact Phone: *

Emergency Contact Relation to Child: *

I hereby give permission for the person registered via this form to participate in all activities, to have
photographs taken of them for advertising purposes, and to receive emergency medical treatment if
necessary.

Check to give permission: *

I give Permission:

Comment *

Submit

Sign up today!

July 11-15, 2022
8:45am-3pm

If you are under 18 years old a parent/guardian must fill our the remainder of the form. If you are a legal adult, YOU will need to fill out the remainder of the boxes, but you can skip parent/guardian's name and contact number.

Medical Information

​Sign up today!

July 11-15, 2022​8:45am-3pm

If you are under 18 years old a parent/guardian must fill our the remainder of the form. If you are a legal adult, YOU will need to fill out the remainder of the boxes, but you can skip parent/guardian's name and contact number.

Medical Information

Sign up today!

July 11-15, 2022
8:45am-3pm