EmailMeForm
Junior High Pioneer/Paintball Camp
June 17-20
Camper Name
*
First
Last
Gender
*
Please select
Male
Female
Birth Date
*
MM
/
DD
/
YYYY
Grade in Fall of 2019
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Email
Home Church Name
Home Church City and State
Primary Contact
*
Please select
Mother
Father
Guardian
Primary Contact Name
*
First
Last
Primary Contact Address (if Different from above)
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Primary Contact Home Phone
###
-
###
-
####
Primary Contact Cell Phone
###
-
###
-
####
Primary Contact Work Phone
###
-
###
-
####
Secondary Contact
Please select
Mother
Father
Guardian
Secondary Contact Name
First
Last
Secondary Contact Address (if Different from above)
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Secondary Contact Home Phone
###
-
###
-
####
Secondary Contact Cell Phone
###
-
###
-
####
Secondary Contact Work Phone
###
-
###
-
####
Emergency Contact Name
First
Last
Emergency Contact Relationship to Camper
Emergency Contact Phone
###
-
###
-
####
Size for Free T-shirt
*
Please select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Name
First
Last
Name
First
Last
