ADULT FORM

Church Camp Registration

Name

First Name

Last Name

Phone

(###)

###

####

How long will you be attending?

(please tick all that apply)

Full weekend

Saturday (day only)

Sunday (day only)

Dietary Requirements

Please note you will be required to fill out a seperate form detailing this for Bethshan

Additional requirements

Emergency contact name

First Name

Last Name

Emergency contact phone number

Relationship to emergency contact

Payment for this registration will be via

Direct deposit

Cash

Debit Card

Will you require financial assistance?

If "yes" Andrew will be in contact with you

Yes

Name of the person/s you'd like in your cabin