Middle School Camp Registration

On May 5, 2022

If you are human, leave this field blank.

Last Name *

First Name *

Address *

City *

State *

Zip *

Phone *

(xxx) xxx-xxxx

Email *

(To receive confirmation of registration.)

Gender *

Grade Completed *

Date of Birth (XX/XX/XXXX) *

Home Church *

Parent/Guardian Name(s) *

Paintball *

Yes, I will allow my youth to play paintball.

No, I will not allow my youth to play paintball.

Emergency Contact Person *

Emergency Contact Person'sPhone *

(xxx-xxx-xxxx)

Medical / Personal Notes

Pay *

$175 Online Now

$175 Cash Later

You must click the "Submit" button on this page in order to complete your registration. Check your SPAM folder if you do not receive an email notification.

I agree to allow my child to attend Middle School Camp 2022. I relinquish New Life Church, Word of Life Church, Life Source Church, ABBA’S Haven, volunteer workers and anyone associated therein of any liability. In case of an emergency, I give permission for my child to be taken to a hospital, or any other emergency facility, and give permission for a medical doctor or hospital to administer any treatment they deem necessary; I will assume full financial responsibility. I do this in faith that all parties involved will give close supervision during all activities and use wisdom with any decisions they will have to make. *

Middle School Camp Registration

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