Camp Pioneer Kids registration form

Registration fees are $50.00 per child to cover craft supplies and include a Camp Pioneer Kids t-shirt. Three or more children qualify for a family registration fee of $125.00. Registration fees are payable by cash or cheque at the church.

Camper 1
Camper 1 Name *
Camper 1 Name
Camper 1 Birth Date *
Camper 1 Birth Date
Camper 2
Camper 2 Name
Camper 2 Name
Camper 2 Birth Date
Camper 2 Birth Date
Camper 3
Camper 3 Name
Camper 3 Name
Camper 3 Birth Date
Camper 3 Birth Date
Camper 4
Camper 4 Name
Camper 4 Name
Camper 4 Birth Date
Camper 4 Birth Date
Parent/Guardian Information
Parent Name *
Parent Name
Parent Address *
Parent Address
Parent Home Telephone Number *
Parent Home Telephone Number
Cell Phone/Work Number *
Cell Phone/Work Number
Emergency Contact *
Emergency Contact
Emergency Contact Number *
Emergency Contact Number