- ON-LINE REGISTRATION

Shiloh Adventure Camp • On-line Registration

Important Note: - Please ensure you provide responses for all items shown with this symbol *.

Requested Session(s): *

Week 1 Session 1A Jun 13-15 (age 8-10)	Week 1 Session 1B Jun 15-18 (age 10-12)
Week 2 SORRY We're Full	Week 3 Jun 27-Jul 2 (age 8-15)	Week 4 Jul 4-9 (age 8-15)

To see Our Camp Registration Fees and Special Discounts CLICK HERE.

CAMPER INFO

Camper's Name: *

First or Nickname:
Last:

Street Address: *

City, State Zip: *

City:
State: Zip:

Home Phone: *

Please include area code.

Birth Date: *

mm/dd/yy

Age & School Grade: *

Age: As of June 13th
Grade Entering Next Fall:

Gender: *

Male Female

Bunk With Preferrence:

Name(s) of 'bunkhouse mate' preferences.

T-Shirt Size: *

Included in registration fee.

Church:

Please provide name and location of the church(es)
that that the camper usually attends.

Previous Shiloh Camper? *

Yes No If yes, what years?

Additional Comments:

Such as group (6 or more) name, camper scholarship
pending, parent in being chaperone or volunteer, or
any other special info.

Additional Campers: *

Other family members attending Shiloh?
Yes No

For additional campers, use the 'back' button of your browser after you click the 'Submit Camper Registration' at the bottom of this page. Then change the camper name, age, gender, etc. and click 'Submit Camper Registration' again. You can repeat this process for as many family members as you'd like.

PARENT/GUARDIAN INFO

Parent/Guardian Name: *

Please provide first and last names of ...
"Pri"mary: *

"Alt"ernate:

Phone Numbers (Pri): *

   Indicate "N/A" if none for any * item.
   Home: *
   Work:
     Cell: *

Phone Numbers (Alt):

   Home:
   Work:
     Cell:

E-mail (Pri): *

E-mail (Alt):

How did you hear about us? *

Other:

EMERGENCY CONTACT INFO

Contact Person's Name: *

Relationship to Camper:

Contact's Phones: *

   Indicate "N/A" if none for any * item.
  Home: *
    Work:
      Cell: * :

RESERVATION OPTIONS

Camp Pictures/Videos:

New! On-line Pic/Video Pass ($5) unlimited downloads
Standard Photo/Video DVD ($10) mailed after camp

Camp Store Card(s):

   Our camp store no longer takes cash. Indicate how
   many campers and a dollar amount to allocate to
   each card.
   No. of campers:    Amount each: $.00

Additional Shiloh T-Shirts:

Indicate quantity and size of extra T-shirts ($10 each)

Special Excursions Sign-up: *	Per Camper, Per Session
Turtle Nesting Night Hike Youth Slots are full, but we will keep a 'Waiting List' if slots become available. Also a few parent driver-chaperones would be welcomed, call (321) 452-3943.	$10.00 $10.00	Yes Adult
Sebastian State Park - Snorkeling in Tidal Pools and Spanish Fleet Museum (Bring your snorkeling equipment)	$5.00	Yes
Sebastian State Park - Snorkeling in Tidal Pools and Spanish Fleet Museum (Includes Snorkel and Mask Rental)	$10.00	Yes

Method of Payment: *

Check/Money Order Credit Card (On-line or Phone-In)

In STEP 3 of registration you'll get instructions on mailing-in your check or using our secure on-line credit card payment system.

REMINDERS/SUGGESTIONS:

Please be sure to download and fill-in the Medical Info and Parent Consent Form.
(Note: the form must be signed and notorized. A camper cannot stay at camp without this form on file at camp.)
Click HERE to download the Medical/Parent Consent Form

Please thoroughly check all the Registration Information for this Camper before you click the "Submit Camper Registration" button.

Also, before you click the button, you may want to print this page from your web browser to keep for your records.

After you click "Submit" you can EITHER register additional campers from your family (by clicking the back button of your browser), OR proceed to Step 3, "Registration Fee Payment" arrangements.

Shiloh Adventure Camp • PO Box 74 Cocoa, FL 32923
Phone: (321) 452-3943 • Fax: (321) 454-4614 • Email: info@shilohadventure.com