PBC REGISTRATION 2018 - 4TH WEEK CAMPER

* Note: Fields with an asterisk require an entry.

Names and Email Addresses

Camper First Name	Camper Last Name
Parent/Guardian First Name	Parent/Guardian Last Name
Main Email	Camper Email (optional)

Address

Address Line 1

Address Line 2

City

States

Postal Code

Country

Phone Numbers

Main Phone

Alternate Phone 1

Alternate Phone 2

Misc. Information

Gender

Male

Female

Birth Date

Must be 9 Years Old by Camp Time

School Grade Just Finished

1st2nd3rd4th5th6th7th8th9th10th11th12th

Food Allergies

Name of Home Church

Rooming Request

Special Information We Need to Know About This Camper

Memo

Select Tee Shirt and Registration Fee

Tee Shirt Size?

Child SChild MChild LAdult SAdult MAdult LAdult XLAdult XXLAdult XXXLAdult XXXXL

Registration Amount You are Paying Today?

Pre-Registration - $75Full Registration - $210

Note: $75 is non-refundable in the event you cancel your registration.

Note: After submitting you will receive an email confirming your registration. If you do not receive the email, please look in your spam folder. The confirmation email contains important information. Thank you!

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