MS Camp Registration—cancelled until next summer!

1. Name *

2. Address, City, ST/ZIP *

3. Grade (completed 5th & up to 8th grade) *

4. School *

5. Gender * Female Male

6. Birthday (must be 11 yrs old by June 27th) *

7. Food Restrictions or Allergies *

8. Student's Email *

9. Student's Phone *

10. Emergency Contact Person / Parent *

11. Phone # Emergency Contact Person *

12. Parent's Email *

13. Parent's Phone *

14. Possible ways to lower your camp cost!

• I would like to apply for a scholarship due to household income
• Angel Tree Scholarship (if you have a parent that has been incarcerated)
• I am interested in doing a fundraiser/work project

15. Camp Payment- the first $50 is non-refundable but is transferable. Check All That Apply --then click (Submit to Pay) *

• I am paying the $50 deposit to reserve my spot
• I am paying in full the Early-Bird Discount for Camp of $225 by April 30th
• I am paying by cash or check (give it to your Campus Life/City Life leader)