IMPORTANT- Pleasemailthis Form Allpaymentsto: Conferencetreasurer

SPRINGHEIGHTS 2018

SUMMER CAMP REGISTRATIONFORM

REMINDER

Youcanregisteronline

Atspringheights.org

CAMPERINFORMATION
CamperName: / DateofBirth:
Gender:MaleFemale / LocalChurch: / Grade Completed:
CamperStreetAddress: / I haveattendedcamp times.
City: / State: / ZIPCode:
Ilivewith:Parent/Guardian#1Parent/Guardian#2BothOther:
PARENT/GUARDIAN INFORMATION
Parent/Guardian#1Name: / Parent/Guardian#2Name:
Address(ifdifferent from camper): / Address(ifdifferent from camper):
City,State,ZIP: / City,State,ZIP:
HomePhone: / WorkPhone: / HomePhone: / WorkPhone:
CellPhone: / Email: / CellPhone: / Email:
Occupation: / Occupation:
CAMPERPROGRAMCHOICEPlease indicatebotha firstand secondchoice incase yourfirstchoiceis full.
1stChoiceProgramName: / 2ndChoiceProgramName:
Datesofmychoice: / Datesofmychoice:
PARENT/GUARDIANCONSENTMysignatureindicatesthat I understandand agreetothetermsand conditionsbelow.
Parent/GuardianSignature: / Date:
TermsConditions:Additionaldetailsregardingcamppoliciesandproceduresareavailableonourwebsiteat aswellasintheconfirmationmaterials(receivedafterregistering),orbycontactingthe camp.Campersunder18yearsofageinanycampmustpresentonarrivalaHealthHistoryandExamination Form signedbya physician anda parent orlegal guardian.In event of accident/illness, thecampadministration haspermission tosecureemergency medicalcare asneeded untiltheparent/guardian canbereached.SpringHeightsisnotresponsible forinjuries,damages,orlossduetoaccidents.Allfeesmustbepaidinfulltwoweekspriortoarrivalatcamp. Permissionisgrantedtousephotosofcampersintheclosingprogram,thewebsite,thesouvenirdisk,groupphotos andmarketingmaterialsandpromotionalpieces.Itistheparent’sresponsibilitytoinformtheCampDirectorofany restrictionsregardingwhomaypickuportransportthecamper.
PAYMENTINFORMATIONImportantnote:a$100.00 depositis requiredto holdyour spot.
TierPrice(Circle One):ABC / ChosenTierPrice:$ / AmountEnclosed:$
TotalAmountParent/GuardianisPaying:$BALANCEDUE(ifany):$
TotalAmountChurchisPaying:$ / Iwould also liketo donatethisamount totheministry of
SpringHeights. Amount: $
(Pleasesendseparatecheckmarked“donation”inmemoline.)
CHURCHPAYMENTAGREEMENT (Onlycompletedifapplicable):
Thissection to be completedbychurchesprovidingallor part ofacamper’sfeesIFthosefees have notbeenincluded with the registration. By signingbelow,thepastor agreesthat his/herchurchwill remit totheconference treasurerthe amount indicatedabove in the“TotalAmountChurchisPaying”blank.NEWTHISYEAR:Full paymentisrequired PRIOR tothecamper’s arrival atcamp.Pleasesendfull payment with registration whenat all possible.
ChurchNameCity: / PhoneNumber:
Pastor’sName(printed): / Pastor’sSignature:

IMPORTANT- Pleasemailthis form allpaymentsto: ConferenceTreasurer

ATTN.CampRegistration

P.O.Box2469

Charleston,WV25329

Questions? Contact Spring Heightsby phone:304.927.5865 or by email:t usonlineat springheights.org. Thank youforchoosingSpringHeights!