Virginia Nazarene Kids Camp Registration
Kidz Camp: July 11-14 (Completed Grades 1-3)
Power Camp: July 17-21 (Completed Grades 4-6)
Camp Address: 1151 High School Rd., Buckingham, VA 23921 (Do Not Mail Registrations to this Address)
Contact us at (434) 515-1425 or email at
Name of Camper
Date of Birth
Which Camp will you be attending?
KIDZ Camp, July 11-14, Completed Grades 1-3
POWER Camp, July 17-21, Completed Grades 4-6
Pastor of Home Church
Example: John Doe, Jane Doe
Request Bunk Buddy
Only one, must be same grade & age.
Camper Shirts included/ leaders shirts $12
“Virginia District Children’s Ministries has permission to use images of my child in print, video, or digital media for the purposes of promoting and/or memorializing District Children’s Camps.”
I do consent to the media release
I do NOT consent to the media release
“In the event that my child would need to be picked up from the campgrounds, by someone other than a parent, the following list of persons is authorized for transportation of the child. I understand that only persons listed will be able to leave the campground with my child and that identification will be required before allowing any child to leave.” Please List the name of the person and the relationship to the child.
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This form was created inside of Lynchburg First Church of the Nazarene.
Terms of Service