Peacebuilders Camp 2020 Registration
Registration for Sessions 1 and 2 is open. Session 3 will be by invitation only. Please set aside 30-60 minutes for the registration process. Though you can save and return to the registration, we recommend you complete it in one sitting, so please ensure you have sufficient time

Contact us for more information: quayneshia@peacebuilderscamp.org
Email address *
Camper's first name *
Your answer
Camper's last name *
Your answer
Name camper likes to be called *
Your answer
Camper's email address
Your answer
Camper's gender *
Camper's Date of Birth *
MM
/
DD
/
YYYY
Camper's grade next school year (2020-2021)
List all languages spoken fluently by camper *
Your answer
Primary adult contact's first name *
Your answer
Primary adult contact's last name *
Your answer
Relationship to Camper *
Your answer
Occupation/Employer *
Your answer
Preferred primary method of contact *
Primary number or email address *
Your answer
Secondary method of contact *
Secondary number or email address *
Your answer
Third number or email address
Your answer
Street Address *
Your answer
Apartment or Unit #
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
How did you hear about Peacebuilders Camp at Koinonia Farm? *
Required
Are you receiving assistance with this registration process? *
Required
If yes above, please provide the name of the individual providing assistance, any affiliated group or organization, and phone/email address for the person providing assistance.
Your answer
Do you want to continue the registration process now or save for later? *
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