Celebrate Me Week Camper Registration
Camper Registration Form

Camper First Name

Camper Last Name

Preferred Name

Mailing Address

City

State

Zip

Home Phone#

Camper E-mail Address

Gender:

Birth Date:
(MM-DD-YY)

Camper must be going into the 7th grade in the fall of 2019
Current School
School Location (City)
Church
Church Location (City)
   

Parent/Guardian Information

Name
Cell/Work Phone
E-mail Address
Confirm E-mail Address
   

Medical Information

CMW provides basic first aid only.

Relevant medical information
(including allergies):

List all medications:

Physician/Treating

 

Professional:

Emergency contact

Relationship

Phone #

Medical Insurance

Address

Policy #

Adult T-shirt size:

   

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 GIRLS ALL openings are FULL! Week 1 BOYS ALL openings are FULL!
  • Week 2 GIRL ALL openings are FULL! Week 2 BOY ALL openings are FULL!
  • Week 3 GIRL ALL openings are FULL! Week 3 BOYS ALL openings are FULL
  • Week 4 GIRLS ALL openings are FULL! Week 4 BOYS ALL openings are FULL!
Please choose which dates you can attend and rank them in order of choice:
First Choice:
Second Choice:
Third Choice:
Fourth Choice:
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.
In case of an emergency, if I (Parent/Guardian) cannot be reached, Celebrate Me Week staff has permission to act on my behalf.
I, hereby, agree to allow my child to be photographed by CMW volunteer photographers during the session attended. Images may be used for future promotions.
Applicant is able to function independently (physically/socially/emotionally) in a camp setting.
   
A $150 non-refundable deposit is required with each accepted application. Balance of $300 due before the beginning date of camp.