MS - Camp Registration Michindoh

1. Name *

2. Address, City, ST/ZIP *

3. Grade (completed 5th & up to 8th grade) *

4. School *

5. Gender * Female Male

6. Birthday (must be 11 yrs old by June 29th) *

7. Food Restrictions or Allergies *

8. Student's Email *

9. Student's Phone *

10. Emergency Contact # 1 -Parent/Guardian name *

11. Emergency Contact # 1 -Phone Number *

12.Emergency Contact # 2 -Parent/Guardian name *

13.Emergency Contact # 2 -Phone Number *

14. Possible ways to cover your camp cost.

• I would like to apply for a scholarship due to household income
• Angel Tree Scholarship (if you have a parent that has been incarcerated)
• I am interested in doing a fundraiser/work project

15. First Camp Payment -($25 deposit is non-refundable): Check All That Apply -then click (Submit to Pay) *

• I am paying the $25 deposit to reserve my spot
• I am paying in full (includes $25 non-refundable deposit)
• I will be paying by cash or check (please give to your Campus Life / City Life Leader)