RefugeOC Youth Winter Camp 2022 Registration Form

RefugeOC Youth Winter Camp 2022

January 28th - January 30th, Pinecrest Christian Conference Center
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact

First NameLast Name
Relationship to Student
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Phone Number
Format: (000) 000-0000.
Email
I give permission and consent for RefugeOC Youth to take photos of my youth during camp.
By signing this document, I give permisssion for my youth to attend RefugeOC Youth Ministry Winter Camp 2022 and participate in all activities.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Once this form is submitted you will receive an email with packing and payment information. If you have any questions please contact Pastor Kai or Pastor Jon. We are very excited for Winter Camp 2022!
Should be Empty: