COGOP Mid-Atlantic Regional Camping Ministry
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Camper's Name: *
Gender:  *
Camper's Date of Birth *
MM
/
DD
/
YYYY
Camper's Current Age *
Parent(s)/ Guardian(s) Name: *
Parent(s)/ Guardian(s) Home Phone: *
Parent(s)/ Guardian(s) or Camper's (Young Adult) Email: *
Street Address: *
Church Name: *
Pastor's Name: *
Church Address: *
Camp Attending *
Name of Emergency Contact: *
Emergency Contact Phone Number: *
Relationship to Camper: *
A copy of your Health Insurance Coverage/Updated Medical Form will need to be provided. Anyone not having verifiable health insurance coverage will be required to take the health insurance coverage through Brotherhood Mutual Camp Insurance Policy that will be sent to each approved applicant. Please complete the digital medical form at  https://form.jotform.com/250474849554165
Camp Price
$250
Please make all payments here at https://www.macogop.org/general-5. 
1. Click one-time payment
2. Click Donations and change it to Camping Ministry
3. Make Payment 
4. In the notes section put your child's full legal name. 
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