Event Registration

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Youth Summer Camp on Sunday, July 25, 2021 @ 9:00 AM

To pay only the deposit, click the arrow on the price box (above) that  currently shows $600 and then select $200 deposit. You may go back and change this selection, if you wish. 
We would like camp to be available to all without financial hardship. If you need a scholarship, please do not complete the registration at this time. To apply for a scholarship, please email swiltz@4thpres.org.


Please provide the information below as a part of your registration.
*Gender:
*Grade Level Next Fall:
*Birthdate:
Insurance Company:
Policy Number:
Group Number:
*Special Needs or Medication:
Please explain special needs and medication:
*allergies (drugs, foods, ect.):
Health Conditions and Physical Limitations:
Home Church:
*Parent/ Guardian Names:
*Parent/ Guardian Address(es):
*Parent/ Guardian Phone Number:
*Emergency Contact:
*Emergency Contact Phone:
*T-shirt Size: