Camp Creation Registration: August 8, 9, 10- from 9AM until 12 Noon
St. John's United Church of Christ

Please fill out this form completely.
Registration is required by July 30
Cost for 1, 2, or 3 days is $15 (this price includes a t-shirt, supplies, and snacks)
Aug. 8 and 9 will be held at the Kiwanis Youth Cabin. Aug. 10 will be at the Dan and Angie Rieder farm.
If you are planning to attend only one or two days, the cost will remain at $15. Please indicate the days you are attending.

Transportation to and from all sites must be provided by parents, and parents/caregivers are welcome to stay with their children.

Thank you!

Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Grade Level *
Child's Birth Date *
Your answer
Child's Allergies *
Your answer
T-Shirt Size (indicate youth or adult and size) *
Your answer
Father's Name and Cell Phone
Your answer
Mother's Name and Cell Phone
Your answer
Home Phone Number
Your answer
Home Address
Your answer
Emergency Contact and Phone Number If Parents Cannot Be Reached *
Your answer
Additional Information *
My child will be attending the following days: *
Required
Your child may be photographed and those photos may be used in worship or for publicity purposes unless you specify that no photos be used. *
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