Mt. Gilead Summer Camp 2008 Registration
We are excited to have you join us for Uncle Gil’s Incredibly Amazing Barnyard Fiasco! Please fill out this form completely. When you have it completed, please mail it along with a signed medical release form and your non-refundable $50 registration fee to insure your camper’s spot at camp.
| First Name: | Last Name | ||
| Gender: | Age: | Birth Date: | Grade in Fall: |
| Address: | |||
| City: | State: | Zip: | |
| Phone #: ( ) | Parents Email: | ||
| Church Attending: | |||
| Has camper ever attended a Mt. Gilead event before?: Yes No | |||
| Roommate Request (no more than 3): | |||
| Bring a friend who has never been to Mt. Gilead Summer Camp before and you and your friend will both receive $25 off your registration fee! Siblings excluded. | Bring A Friend Name(s): | ||
| Campers belonging to the same legal guardian will receive a discount. $25 for each additional camper. For example a family of 4 campers will receive a total of $150 in discounts (camper 1 is full price, camper 2 gets $25 off, camper 3 gets $50 off and camper 4 gets $75 off). | Family Discount: | ||
| Health Care Provider: | Policy #: | ||
| Date of last Tetanus: | Dr. Name: | ||
| Dr. Office Phone #: ( ) | Medications/Allergies: | ||
| Emergency Contact Name (other than parent): | |||
| Emergency Contact Phone #: ( ) | |||
| Dietary Concerns: | |||
| Mother's First Name: | Mother's Last Name: | ||
| Mother's Phone #: ( ) | Work Phone #: | ||
| Mother's Address: | |||
| Mother's City: | Mother's State: | Mother's Zip: | |
| Father's First Name: | Father's Last Name: | ||
| Father's Phone #: ( ) | Work Phone #: ( ) | ||
| Father's Address: | |||
| Father's City: | Father's State: | Father' Zip: | |
| Pre-Order | Camp Shirt ($10) | Yes No | Size: |
| Highlights DVD ($17) | Yes No | ||
| Camp Photo ($5) | Yes No | ||
| Camp Attending: All campers registering before May 1 receive a $20 discount |
High School #1 June 15 - 21 ($373) |
Junior High #1 June 22 - 28 ($356) |
Junior Camp #1 July 6 - 11 ($323) |
| High School #1 July 27 - Aug 2 ($373) |
Junior High #2 July 20 - 26 ($356) |
Junior Camp #2 July 13 - 18 ($323) |
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| Payment Type: Credit Card ATM Check (enclosed) | |||
| Card Type: Visa Mastercard | Card #: | ||
| V-Code: | Exp.: | Amount to charge: $ | |
| Cardholder's Signature: | |||