Camper Name

Male Female | Age | Grade Entering Select... 10th Grade 11th Grade 12th Grade

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

I would like to be in a cabin with

*Preference is give to pre-registered campers.

Need help? Go to Registration Help for answers.

 

Camp Fee

T-Shirt Select... 0 - $0 1 - $12 2 - $24 3 - $36 4 - $48 5 - $60 Sweatshirt Select... 0 - $0 1 - $20 2 - $40 3 - $60 4 - $80 5 - $100 Picture CD ($10)

Money for Mission Credit for Canteen

Church Scholarship From Amount (Subtract from total)

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 June 10th 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, 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

Please print this page for your records before submitting.