Summer Registration

Online registrations must be paid online. When you submit this form you will be directed to Paypal to complete your payment. Registrations will not be processed unless payment is received. Only a $45 deposit must be paid at this time, though you have the option of paying the entire amount. A $1 online processing fee applies to deposits and a $5 fee for the entire amount. Fees are as follows:
-Day camp - $110 ($115 with online payment fee)
-Overnight Camp -$195 ($200 with online payment fee)
*Camp fees include lodging, meals, crafts, activities, a Keepsake DVD, and a T-Shirt. Optional activities may be offered at Teen Camp for an extra fee.

Space is limited. Registration is complete when both your form and deposit are received. You will receive a confirmation letter in the mail.


	Summer 2010 Camp Registration


	Camper’s name:


	Goes By:


	Birth Date:


	Race:


	Gender:


	Age:


	Grade (09-10):


	Male


	Female


	Mailing Address:


	City:


	State:


	Zip Code:


	Parents/Legal Guardians:


	Home Phone:


	Cell Phone:


	Please use dashes in phone numbers.


	Work Phone:


	Emergency Contact other than parents:


	Emergency contact’s phone number:


	How did you hear about Camp Grace?


	Did you do Mailbox Club lessons this year?


		E-Mail Address:


	Did you do Correspondence lessons this year?


	Do you attend church?


	Name of Church:


	Cabin Mate Request:

*You may only request one friend. Your friend must also request you.*

Please mark the week you plan to attend.
Grades are based on the grade student is entering in the fall.


		June 13-18 Teen Camp Grades 9-12

		June 20-25 Middle School #1 Grades 5-8

	June 27-July 2 Elementary #1 Grades 3-5

		July 5-9 Day Camp Grades 1-3

		July 11-16 Middle School #2 Grades 5-8

		July 18-23 Elementary #2 Grades 3-5

		July 25-30 Middle School #3 Grades 5-8


	Select Week Here:


	T.E.A.M


	Please mark here if you wish to be scheduled for a week of service as a TEAM member. Grades 9-12 only. TEAM members are expected to attend Teen Camp*


	Choose your T-Shirt size. Every camper receives a camp shirt.


	Transportation:


	Day Campers Only! Mark here if you would like help with transportation. There is an extra fee of $20 per child. If there are less than 20 riders the fee will be $25.


	Note: The bus stops are at McDonald’s in Lumberton at Exit 17 and Wal-Mart at Exit 22 between 8:15 & 8:45 AM and between 4:30 & 5:00 PM.

By clicking submit I agree to the following:
-I agree to have my child’s immunizations current and a notarized medical form completed before entering camp.
-I give my child permission to participate in the entire camp program unless otherwise listed on the medical form.
-I give permission for my child to be photographed/videotaped for the purpose of promoting Camp Grace.
-I understand that if my child misbehaves or brings unacceptable items he/she will be sent home without a refund.


	[Summer Registration]