Summer Camp 180
Please fill out this form and click submit.
Please fill out a registration form for each teen, and click submit.
Youth Name
*
Male/Female
*
Please select one option.
Male/Hombre
Female/Mujer
Age
*
Date of Birth
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Home Phone
*
Cell Phone
*
Parents Name
*
Home Church
*
I give my youth permission to participate in all activities and programs during Faith Pleases God’s Camp 180. I agree that Faith Pleases God Church WILL NOT be held responsible for accidents or personal injury arising there from. I also realize that my youth may be in photographs taken during the Camp 180 week. I waive the right to inspect or approve the photo if used for publications or publicity. By Typing your name you agree with this consent.
*
Submit
Description
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