(For office use only) / 2017APOSTOLIC CHRISTIAN CHURCHPART-TIME ONLY
Eastern Camp Part-Time Application Please Print Clearly
Name: / AGE on July 22, 2017
Address:
StreetCityStateZip / Date of Birth: //
Mo.DayYr
Area Code & Phone #: / Email Address: / Year Baptized:
HomeChurch: / Gender : Male Female
Marital Status: Single Married Widowed Engaged
VOLUNTEER TASKS - Members, pleasecheck the positions you are willing to volunteer for during Camp week. Thank you! (Please choose 2)
Song Leader Piano / Organ (circle)
Adult Choir / Dining Room Helper
Athletic Helper
Usher / Craft Helper______
Baby Sitter______
Recess Helper ______
Story Hour Helper______
Jr. Church Helper______/ AUDIO
Lehman jobs- choose 1
Auditorium Lighting
Auditorium Mixing/Recording
Video Recording
Stage Helper
Production Manager
Other Technical jobs, choose 1
CD Sales
Digital Editing
CD Duplication /
Orchestra
Instrument
# Years Played
Remarks:
Roommate or suite sharing requests, please. (Attach note for more detail. Teens – you can request 2 roommates.
Make check or money order payable (in U.S. funds only) to: APOSTOLIC CHRISTIAN CHURCH. MasterCard & Visa are also accepted.
Complete, sign, and return application with FULL PAYMENT to: Brenda Gutai, 1643 Hidden Oak Trail, Mansfield, OH44906
I have read the information on the attached sheet and agree to abide by all guidelines.
Are your parents attending Camp?
YES NO / IF NO: Name of Guardian:
Application will not be processed without this information.
Applicant's Signature* / Parent’s Signature * / Guardian's Signature *
- For anyone 17 and under who comes to Camp without a parent, these are the requirements: Parent’s Signature,
Guardian’s Signature, and a completed and signed Medical Release/Liability Form (see General Information sheet for details.)
PART-TIME RATES– Remember to add Registration Fee based on date of remittance
Day of Week you will be arriving: First Meal - Breakfast, Lunch, or Dinner (please circle choice)
Day of Week you will be leaving: Last Meal - Breakfast, Lunch, or Dinner (please circle choice)
To calculate your payment, multiply the number of nights you are staying by the price under the appropriate column, then multiply the number of each meal you plan to eat by the price indicated. Write the total amount in the Total column, making sure you include all extra charges and the non-refundable registration fee based on the date registration is made. Add it all together, and put total in the TOTAL AMOUNT DUE box.
NUMBER OF / # Days / Adults & Teens / Children 8-12 / Children 0-7 / Put amount in box
Staying at EMU / Nights – Deluxe Room
Adult or Teen / X / 40.00 / 5.00 / Registration Fee Only
Staying Off Grounds / Days - Adult or Teen / 20.00 (Max $100)
Breakfast / X / 4.95 / 2.75 / Registration Fee Only
Lunch / X / 7.15 / 4.15 / Registration Fee Only
Dinner / X / 8.25 / 5.25 / Registration Fee Only
EXTRAS
LINENS – must be ordered with this application...... / 7.00
Donations – any amount given will be used to help those who cannot afford to come to Camp (tax deductible)......
REGISTRATION FEES – non-refundable / Remember to add the correct Registration Fee
Registration Fee – on or before June 1, 2017...... / 20.00
Registration Fee – if received between June 2 - June 15, 2017...... / 30.00
Registration Fee – if received between June16 - July 1, 2017 ...... / 40.00
Registration Fee – if received after July 1, 2017 - July 15, 2017...... / 50.00
Registration Fee – CampWeek...... / 60.00
Credit Card
Payment Information
MasterCard & Visa Only / Expiration Date / $
Month / Year / Total Amount Due