2016 Camp Agapé Summer Camp Registration Form
Please fully complete registration form. If you have any questions, please call our registrar, Melissa 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.

Camper's First Name *
Your answer
Camper's Last Name *
Your answer
Camper's Address-Street *
Your answer
Camper Address-City, State, & Zip *
Your answer
Camper's Gender *
Camper Grade Entering Fall 2016 *
Camper Date of Birth *
MM
/
DD
/
YYYY
Camper's Home Church
Your answer
Roommate Request
note: requested roommate must also request your camper
Your answer
Share Camper needs
Foods, Activities, Fears, etc
Your answer
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