HS - Camp Registration NorthBay

1. Name *

2. Address, City, ST/ZIP *

3. Grade Completed (8th up to Graduation) *

4. School *

5. Gender * Female Male

6. Birthday *

7. Food Restriction or Allergies *

8. Student Email

9. Student Phone

10. Emergency Contact # 1 Parent/Guardian *

11. Emergency Contact # 1 -phone number *

12. Emergency Contact # 2 Parent/Guardian *

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)