2017 Urshlem Women's Summer Camp
Sunday, July 16, 2017 - Wednesday July 19, 2017
Deadline for registration: Wednesday, May 31, 2017
Registration Fee: $50.00

Please be sure to send registration fee to:
Ms. Sophy Cherian c/o DS-WA MGOCSM
4123 Lake Vista Circle, Missouri City, TX 77459

First Name
Your answer
Middle Initial
Your answer
Last Name
Your answer
Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade Level
Reminder: Must be at least an upperclassmen in high school to attend. Also, choose the grade level that you will be entering into for the following academic year.
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
E-Mail Address
Your answer
Phone Number
(ex. 000-000-0000)
Your answer
Allergies
Enter N/A if not applicable
Your answer
Emergency Contact Name
First and Last Name
Your answer
Emergency Contact Phone Number
Number to reach individual in case of an emergency (ex. 000-000-0000)
Your answer
Emergency Contact's Relationship to You
What is the relationship between the emergency contact and you?
Your answer
Parish Name and Location
ex: St. Thomas Orthodox Church, Chicago, IL
Your answer
Parish Vicar
Your answer
T-Shirt Size
Waiver
I as an attendee/participant of the 2017 Urshlem Summer Camp acknowledge and accept the responsibility of safety, liability and medical insurance for myself in case of any emergency and will not hold the Office bearers, Coordinators, or participants of the 2017 Urshlem Summer Camp responsible. In case of an emergency, I give my permission for emergency medical treatment. I take full responsibility to abide by the rules and regulations of the MGOCSM and DS-WA Diocesan Center. I, hereby, agree to follow those rules and regulations set by the above-mentioned organizations, and am aware that any failure to do so, may result in my dismissal from the camp site, and if necessary, appropriate legal action may be taken against me. I am aware that it is my responsibility to attend the sessions as scheduled and to maintain the Christian atmosphere of the camp.
Questions or Need More Information?
For any questions/concerns contact:
Lijin Raju: lijin.h.raju@gmail.com
Kripa Varghese: varghesekripa@gmail.com
Sharon John: sharonj95@gmail.com
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