Camper Registration

SELECT A CAMP

CAMP	DATE	FEE	Required Deposit
A-Five 3	6/22-28	$394	$100
A-Five 4	6/29-7/5	$394	$100
A-Five Max	6/15-21	$414	$100
ADV ROCK8	7/27-8/2	$394	$100
AV1	6/8-14	$334	$50
AV2	6/15-21	$334	$50
AV3	6/22-28	$344	$50
AV4
AV5	7/6-12	$344	$50
AV6	7/13-19	$344	$50
AV7	7/20-26	$344	$50
AV8	7/27-8/2	$344	$50
AV9	8/3-9	$334	$50
BBALL1	6/8-14	$384	$50
HS2	6/15-21	$394	$50
HS3	6/22-28	$404	$50
HS4
HS5	7/6-12	$404	$50
HS7	7/20-26	$404	$50
HS8	7/27-8/2	$404	$50
HS9	8/3-9	$394	$50
MOAB1	6/8-14	$424	$100
MV1	6/8-14	$304	$50
MV2	6/15-21	$304	$50
MV4		$
MV5	7/6-12	$314	$50
MV6	7/13-19	$314	$50
MV7	7/20-26	$314	$50
MV9	8/3-9	$304	$50
PC 3.0	6/22-25	$157	$50
PC 3.5	6/25-28	$157	$50
PC 8.0	7/27-30	$157	$50
PC 8.5	7/30-8/2	$157	$50
PEDAL6	7/13-19	$424	$100
RAPIDS2	6/15-21	$424	$100
RAPIDS5	7/6-12	$424	$100
RM BACK8	7/27-8/2	$374	$100
RW7	7/20-26	$394	$100
SOCCER6	7/13-19	$354	$50
Summer Discount 2009	--	$50
TEEN IMPACT1	6/8-26	$854	$100
TEEN IMPACT2	6/29-7/17	$854	$100
TEEN IMPACT3	7/20-8/7	$854	$100
TP1	6/8-14	$324	$50
TP2	6/15-21	$324	$50
TP3	6/22-28	$334	$50
TP4
TP5	7/6-12	$334	$50
TP6	7/13-19	$334	$50
TP7	7/20-26	$334	$50
TP8	7/27-8/2	$334	$50
TP9	8/3-9	$324	$50

Choose Camp – See Schedule & Fees if you need to review Camps and weeks

Make Your Camp Selection From The Pop Up Below

CAMPER INFORMATION

Camper Last Name	Camper First Name	Camper Nickname

Camper Address	City	State	Zip Code

Gender	Birthday	Grade Entering Fall 2008
MF
Where does camper go to church?	Church's Phone	City Where Church Is

T-Shirt Size
c-s (6-8)c-m (10-12)c-l (14-16)a-sa-ma-la-xla-2xla-3xl
Camper Lives With
Both ParentsMotherFatherGrandparentsOther relativeFoster FamilyOther Person
Preferred non-emergency methods of Communication
Confirmation	Other
MailEmail	Home PhoneCell PhoneWork PhoneEmail
The camper has allergies to:
PeanutsOther NutsDairyGlutenOtherNone Known
If "Other", please explain
The camper requires a special diet
YesNo
If "yes", please explain
The camper takes medication:	RoutinelyOccasionallyNever
If camper needs to bring medicines with him/her, please have doctor fill out “2008 Medication Form”. See Medication Form (pages 7-8) for complete explanation.
Is the camper allowed to swim?	What is the campers swim level?
YesNo

The State of Colorado requires that ALL the following information be filled out completely.

Father/Guardian's Name	Relationship?	Preferred Emergency Methods of Communication
		MailEmailHome PhoneCell PhoneWork Phone
Father/Guardian's address (if different than camper's)	City	State	Zip

Father/Guardian's Home Phone	Cell Phone	Work Phone	Email Address

Place of Employment

Address of Employment	City	State	Zip

Mother/Guardian's Name	Relationship?	Preferred Emergency Methods of Communication
		MailEmailHome PhoneCell PhoneWork Phone
Mother/Guardian's address (if different than camper's)	City	State	Zip

Mother/Guardian's Home Phone	Cell Phone	Work Phone	Email Address

Place of Employment

Address of Employment	City	State	Zip

Other Emergency Contact	Relationship?	Preferred Emergency Methods of Communication
		MailEmailHome PhoneCell PhoneWork Phone
Emergency Contact's Address	City	State	Zip

Emergency Contact's Home Phone	Cell Phone	Work Phone	Email Address

Place of Employment

Address of Employment	City	State	Zip

Persons Authorized to pick up camper (if different than above)

Persons NOT PERMITTED to pick up Camper

INSURANCE INFORMATION

DOCTOR'S INFORMATION

DENTIST'S INFORMATION

Selected Camp

Credit Card Type

Credit Card Number

Credit Card Security

Credit Card
Expiration

Charge Amount

Please check your form and make sure that it is complete and correct prior to pressing the "Submit" button.

Camp IdRaHaJe Camper Registration