Fellowship Youth Camp 2019 Registration Form

Fellowship Youth And Family Camp 2019
Registration Form
1476 Lancaster Pike
Circleville, Ohio 43113
July 8-12, 2019
Register early; pay at the door.

Fee Schedule:

Preregistration Fees: $185 per person for the week.
Registration at the door: $225 per person for the week.
Meals only: $8.50 per meal or $21 for the day.

LAST Name of FYC Attendee *

Your answer

FIRST Name of FYC Attendee *

Your answer

FYC Date of Arrival *

YYYY

FYC Date of Departure *

YYYY

Attendee's Age *

Your answer

FYC Attendee's Address *

Your answer

FYC Attendee's Phone Number *

Your answer

FYC Attendee's Email *

Your answer

FYC Attendee Staying in Youth Dorm? *

Male

Female

All youth 12-18 must have a parent/guardian-signed permission slip for medical treatment in case of emergency. Please indicate your understanding of this.This link will take you to the permission slip for download and completion: https://drive.google.com/file/d/1nDLB424S3xOF8Mf_O3VNUOMfE-M7TrE-/view?usp=sharing *

I understand

FYC Attendee's Parents’/Guardians’ Names (For campers 18 and under, not emancipated) *

Your answer

FYC Attendee's Parents’/Guardians’ Daytime AND Nighttime Phone *

Your answer

FYC Parents’/Guardians’ Address *

Your answer

FYC Attendee's Parents’/Guardians’ Email *

Your answer

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