2017 Agapé Kure Beach Ministries Summer Camp Registration
Please fully complete registration form. If you have any questions, please call or email Ava, the Agapé Program Director, at 919-552-9421 or program@agapekurebeach.org.

If you are having trouble moving between fields on the form, use the "tab" key to navigate to the next section.

Camper's first name:
Your answer
Camper's last name:
Your answer
Camper's street address:
Your answer
Camper's address city, state, zip:
Your answer
Camper's gender:
Camper's grade fall 2017
Camper date of birth
MM
/
DD
/
YYYY
Camper's home church
Your answer
Roommate request
Both campers must request each other in their registration. If you have requests such as siblings NOT being housed together, please include that information within registration too.
Your answer
Does your child have any of the following?
Required
If you have checked any of the boxes above to indicate dietary needs, please explain here:
Your answer
Please share camper needs:
Fears, behavioral concerns, activity restrictions, etc. Anything we should know to provide the best experience for your camper.
Your answer
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