CHYC Online | Registration | Family Camp Registration


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Christian Harbor Youth Camp 28110 264th St. Holcombe, WI 54745 715 - 595 - 4880 Camp Managers Russ and Rebecca Kinney 28110 264th St. Holcombe, WI 54745 715 - 595 - 4880 or 715 - 403 - 1940 christianharbor@gmail.com Treasurer Maria Stone 10520 24th Street Eau Claire, WI 54703 Webmaster Jeremy Coggins webmaster@chyconline.org	Submit a seperate form for each camper. Camper Name Male Female \| Age \| Grade Entering Camper Name Male Female \| Age \| Grade Entering Camper Name Male Female \| Age \| Grade Entering Camper Name Male Female \| Age \| Grade Entering Camper Name Male Female \| Age \| Grade Entering Camper Name Male Female \| Age \| Grade Entering Address Line 1 Address Line 2 City State Zip Code Home Phone (ex. 555-555-5555) Cell Phone E-mail Church You Attend Church's City Zip Code Need help? Go to Registration Help for answers. Number of Adults (12-Adult: $75.00) Number of Youth (Age 6-11: $45.00) Number of Children (Age 5 & Under: FREE) (Add boxes together) ($220.00 MAX) Camp Fee $ Late Fee ($10) Total $ (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 to avoid late registration fee. Need help? Go to Registration Help for answers. Submit form and all payments to CHYC by July 26th to avoid $10 late fee! Submitting this form constitutes your signature, affirms that the information furnished in this registration form is true, complete, and correct and authorizes the processing of this camper registration form. By submitting this form below, you also herby give consent for Christian Harbor Youth Camp to use pictures of yourself to promote the camp. PLEASE REVIEW FORM BEFORE SUBMITTING TO ENSURE ACCURACY Please print this page for your records before submitting.
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