2017 Agapé Family Camp Registration
Please fully complete registration form. If you have any questions, please call our Camp Agapé office at 919-552-9421.

If you are having trouble moving between fields on the form, use the "tab" key to navigate to the next section.

Name of family contact
Your answer
Email Address
Your answer
Phone Number
Your answer
Alternate Phone Number
Your answer
Address
Your answer
City, State
Your answer
Zip Code
Your answer
Home Church
Your answer
Other Participants' names listed:
Please put children's ages after names or designate as adult
Your answer
Number of family members attending:
Your answer
Where would you like to stay during your Family Camp?
Would you like linens provided? (additional $8.50 per person)
Special needs or Dietary Concerns:
Your answer
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