2016 Youth and Children's Camp Registration Form
For which camp are you registering? *
Camper's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Grade in School (2016-17 school year) *
What school did the camper attend during the 2015-16 school year?
Your answer
What school will the camper attend during the 2016-17 school year?
Your answer
Parent's Name (if camper is under 18) *
Your answer
Home Phone *
Your answer
Alternate Phone
Your answer
Home Address (Street, City, State, Zip Code) *
Your answer
Email Address
Your answer
Is the camper a swimmer? *
Any food requirements? *
Required
Please list any food allergies and/or restrictions:
Your answer
Non-food allergies:
Your answer
Please describe any previous camp experience the camper has had: *
Your answer
Is the camper attending camp with a relative or friend?
If yes, please describe their name and relationship.
Your answer
Do you foresee any special challenges the camper may face at camp this year?
Your answer
Thank you for registering for the 2016 Midwest Christian Community Camp!
To secure your registration, please send payment in full of $600 for Youth Camp (excluding camp counselors) or $750 for Children's Camp to The Christian Community, 2135 W. Wilson Ave, Chicago, IL 60625. Your cashed check is confirmation of your registration. Checks may be made out to The Christian Community. PayPal may also be used.

No individual should be kept from camp for financial reasons. If you are not able to make the full payment at the time of registration, fill out and sign the Intent to Contribute form (http://goo.gl/forms/YqVmP0o5WO). When this form is received and approved, your registration is complete.

If you are able to give more than the base fee, please consider making a gift to the camp in order to make it possible for others to attend. Together we all make camp happen.

A medical information sheet and full packing list will follow.

Cancellation before June 1st is possible with a full refund. No refunds are possible after June 1st. Because of the community building nature of camp we ask for your understanding that a camper is expected to stay for the full camp time, barring any medical or family emergencies.

For questions and concerns, please contact Rev. Ann Burfeind: annburfeind18@gmail.com - (773) 877-9255,

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