Camper Registration Form
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Camper First Name
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Camper Last Name
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Mailing Address
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City
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State
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Zip
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Home Phone#
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Camper E-mail Address
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Gender:
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Birth Date:
(MM-DD-YY)
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Camper must be going into the 7th grade in the fall of ‘12
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Current School
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School Location (City)
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Church
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Church Location (City)
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Parent/Guardian Information
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Name
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Cell/Work Phone
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E-mail Address
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Medical Information
CMW provices basic first aid only.
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Relevant medical information
(including allergies):
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List all medications:
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Physician/Treating
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Professional:
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Emergency contact
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Relationship
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Phone #
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Medical Insurance
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Address
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Policy #
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Adult T-shirt size:
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Camp Selection
We have reached our maximum number of participants in the following sessions for the listed school/city/gender. If you would like to have your applicant placed on a waiting list, continue to register. Waiting List applicants do not need to complete the payment process. We will only accept a deposit if when we know we have an opening for the camper. Thank you!
- Week 1: Registration closed for ALL GIRLS (any school)and Maple River boys.
- Week 2: Registration closed for ALL GIRLS(any school)and Willow Creek boys.
- Week 3: Registration closed for ALL GIRLS and ALL BOYS (any school). All camper applicants will be placed on a Waiting List.
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As a parent/guardian, I understand potential campers will be on a waiting list until
this application is processed and acknowledged by Celebrate Me Week.
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In case of an emergency, if I (Parent/Guardian) cannot be reached, Celebrate Me
Week staff has permission to act on my behalf.
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A $105 non-refundable deposit is required to register. Balance of $200 due before the beginning date of camp.
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