Living Water Camp - Campers
Dates: June 20-23, 2019
Cost: $100 Ask us about our IP Blessing Fund (if needed or how to contribute for others)
Event Address: Isaiah's Place 231 HCR 1207 Whitney TX 76692
Contact us at 254-205-7880 Cell/Txt 254-694-7771 dfrederickson1207@gmail.com
Email address *
Camper's Name *
Your answer
Male/Female *
Required
Grade (finished) *
T-shirt Size (adult sizes)
T-Shirt Size (youth sizes)
Birth Date
MM
/
DD
/
YYYY
Address *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian phone or best contact method *
Your answer
Insurance information & policy# (provide photo copy) *
Your answer
Medicines, Medical, Allergy, Dietary notes *
Your answer
Immunization information (including Tetanus) *
Required
What days will you attend? *
Required
$25 due with registration (transferable) $75 upon arrival *
Required
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