EmailMe Form - Senior High Summer Camp 2015

Student's Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code

Primary/Home Phone *

### - ### - ####

Gender *

male

female

School student will attend in 2015-16 school year: *

Student's grade for the 2015-16 school year: *

Does this student regularly attend First Free Student Ministry Programs? *

Yes

No

Roommate Request

We will do our best to place you with at least one of your roommate requests.

1st Roommate Choice

2nd Roommate Choice

3rd Roommate Choice

Please select camp t-shirt size (you may receive an alternate size)

Small

Medium

Large

X-Large

Parent/Guardian Full Name *

Parent/Guardian Emergency Number *

### - ### - ####

Email *

We will communicate any last minute camp info through parents' emails. Please include your email address.

Payment Option *

If you choose half payment, you will be invoiced for the remaining amount. Remaining payment must be received in full by JUNE 7. Amount includes a $100 fee that cannot be refunded if you cancel.

Scholarship Code *

Scholarship level *

Tax deductible scholarship donation

$ Dollars . Cents

Your donations help make camp available to all students. Please consider donating any amount, which will be added to your total.

All consent and medical forms must be returned to the Student Ministry office NO LATER THAN JUNE 7. Download your forms from efree.org.

Paper copies of all forms are available on Sunday morning and evening at Senior High, or at the Student Ministry office M-F, 10am-4pm.