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Week(s) Attending and Date? * |
ON-LINE REGISTRATION
CAMPER SECTION Week X, mm/dd |
| Camper's Name * |
First Last |
| Address * |
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| City,State Zip * |
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| Home Phone * |
Include Area Code (XXX) XXX-XXXX |
| Birth Date * |
mm/dd/yyyy |
| Age * |
Grade Entering * |
| Gender * |
Male Female |
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PARENT SECTION |
| Parent/Guardian * |
First Last |
| Address (If different than above) |
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| City,State Zip |
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| E-mail Address * |
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| Confirm Email Address * |
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| Home Phone * |
Include Area Code (XXX) XXX-XXXX |
| Work Phone |
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| Cell Phone |
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| In case of emergency, who can we contact other than the above |
| Name * |
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Emerg Contact Phone *
Add'l Contact Phone |
Include Area Code (XXX) XXX-XXXX |
| Relationship * |
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What church does the camper attend including address and phone number? |
If you are new to Shiloh, how did you hear about us? * |
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Additional Comments:
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Such as name of 'bunkhouse mate' preference, scholarship application pending, group (6 or more) name, or any special info. |
Other family members attending Shiloh Adventure Camp? Yes No Please submit a separate form for each child.
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| Camper's T-Shirt Size |
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Method of Payment: |
Check Credit Card |
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Please be sure to download and send in the required Medical Info and Parent Consent form. (Note: The form must be signed and notorized. A camper can not stay at camp without this form on file.)
Download Medical/Parent Consent Form here |