Christian Harbor Youth Camp Registration Form

Week of Camp Attending: Empty Nesters' Camp

Submit a seperate form for each camper.

Camper Information

Camper Name

Male Female Age

Address Line 1

Address Line 2

City State Zip Code

Home Phone (ex. 555-555-5555) Cell Phone

E-mail Address

Church You Attend

City Zip

Cabin Requested* I want to be in a cabin with*

*Preference to requests are given to preregistered campers.

Registration Form Help

Financial Information

Camp Fee

Camp T-Shirt ($12 Each) - Qty Camp Photo CD ($10 each) - Qty

Money for Mission Credit for Canteen

Other: Amount

Church Scholarship From: Amount (Subtract this amount from total)

Total Due $

(Add all boxes in the financial section and insert this number into the total due box. This is the amount to be paid to CHYC)

**Registration must be recieved by CHYC 2 weeks prior to start of chosen week of camp and paid in full to avoid late registration fee.**

Registration Form Help

Methods of Payment

Please make checks payable to CHYC

Send checks to:

Christian Harbor Youth Camp

28110 264th St.

Holcombe, WI 54745

Submit form and all payments to CHYC by July 5th to avoid $10 late fee!

Entering your name below constitutes your signature, and confirms that you are the Parent/Guardian of the camper listed on this registration and affirms that the information furnished in this registration is true, complete, and correct and authorizes the processing of your camper registration. By entering your name below, you also herby give consent for Christian Harbor Youth Camp to use pictures of your child to promote the camp.

Parent/Guardian

PLEASE REVIEW FORM BEFORE SUBMITTING TO ENSURE ACCURACY

Confused about the registration form for unsure about how to enter monetary values? Please click here for help.