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
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