Virginia Nazarene Kids Camp Registration
Kidz Camp – July 11-14, Completed Grades 1-3
Power Camp - July 17-21, Completed Grades 4-5

Camp Address: 1151 High School Rd., Buckingham, VA 23921

Registration Questions: mmckenzie@lynchburgnaz.com

Email address
Name of Camper
Your answer
Sex
Date of Birth
MM
/
DD
/
YYYY
Which Camp will you be attending?
Required
Completed Grade
Home Church
Your answer
Pastor of Home Church
Your answer
Legal Guardian(s)
Example: John Doe, Jane Doe
Your answer
Address:
Your answer
State:
Your answer
Zip:
Your answer
Phone (Home):
Your answer
Phone (Cell):
Your answer
Request Bunk Buddy
Only one, must be same grade & age.
Your answer
Shirt Size:
Camper Shirts included/ leaders shirts $12
Media Release
“Virginia District Children’s Ministries has permission to use images of my child in print, video, or digital media for the purposes of promoting and/or memorializing District Children’s Camps.”
Pickup Release
“In the event that my child would need to be picked up from the campgrounds, by someone other than a parent, the following list of persons is authorized for transportation of the child. I understand that only persons listed will be able to leave the campground with my child and that identification will be required before allowing any child to leave.” Please List the name of the person and the relationship to the child.
Your answer
Dietary restrictions
Next
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