Youth Camp Registration – Remedy Church

Youth Camp Registration

Youth Camp Registration

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Child Information

Name

First

Last

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Date of Birth

Grade

Parent/Guardian Information

Name

First

Last

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Email

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact

Name

First

Last

Phone

Medical Concerns

Layout

Registration Deposit

Deposit (Hold My Spot) - $50.00

Registration Full

Full Registration (Oh I'm GOING!) - $300.00

Payment Information