Preteen Retreat - Camper Registration
4th - 6th Grade Students - Shiloh Park - October 26-28, 2018
Camper's Full Name *
Your answer
Camper's Birthdate *
MM
/
DD
/
YYYY
Camper's Gender *
Camper's Grade in School (2018-2019) *
Camper's Food Allergies *
Required
Camper's Special Needs, Medical Conditions, or Diagnosis
Your answer
Camper's Home Address *
Your answer
Parent / Guardian Name *
Your answer
Parent / Guardian Phone Number *
Your answer
Additional Parent / Guardian Name
Your answer
Additional Parent / Guardian Phone Number
Your answer
Full Name of Home Church *
Your answer
City of Home Church *
Your answer
District of Home Church *
Roommate Preference (campers will be placed in a cabin with the other children from their Home Church)
Your answer
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