Registration for Camp Blessing
Camp Blessing | Brenham TX | June 12 - 18, 2017 | $225
Students must be age 16 and up to be a counselor at Camp Blessing.
Space is on first come/first serve basis and is limited to 9 male students and 9 female students. We will ride together as a group to Camp Blessing from FPC on Monday 6/12, and return to FPC on Sunday 6/18.
Last Name of Student
Your answer
First Name of Student
Your answer
Gender
Grade
School
Your answer
Parent Email Address (primary)
Your answer
Parent Email Address (secondary)
Your answer
Mother's Cell #
Your answer
Father's Cell #
Your answer
Student's Cell #
Your answer
Emergency Contact (if parents can't be reached)
Your answer
Emergency Contact # (if parents can't be reached)
Your answer
Medical Insurance Provider
Your answer
Medical Insurance Phone #
Your answer
Medical Insurance ID
Your answer
Medical Insurance Group #
Your answer
List any allergies or medical conditions:
Your answer
(For Students) I understand that I will be sent a link to the Camp Blessing website and that I still need to register with Camp Blessing in order to be a counselor with the FPC group.
Required
(For Parents) I hereby give permission for my child to attend Camp Blessing as a counselor from June 12-17, 2017, riding as a passenger in church rented bus or van. I also give permission for any member of the FPC Youth Team and/or Camp Blessing Staff, in the event of an emergency, to seek dental &/or medical attention necessary for my child.
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of First Presbyterian Church. Report Abuse - Terms of Service - Additional Terms