Camp Swatara Registration Request
#firstName #lastName for #camp1.campName or #camp2.campName
Registration Request ID #registrationRequestID

Camper:
 #firstName #lastName
Gender:
 #gender

Grade: #gradeCompleted Birthdate: #birthDate (age at camp: #ageAtCamp)
Address:
 #addr1
#city, #state #zip
Church:
 #churchName (pastor #pastorName)
 

Parent
 #parentName
 

Home Phone
 #phoneHome
Cellphone
 #phoneCell
Email
 #email


Camp Choice #1
 #camp1.campName
Camp Choice #2
 #camp2.campName


Cabin Mate Request:
 #cabinMateRequest
Attend Camp Swatara Before:
 #attendCampBefore
First Time Away From Home:
 #firstTimeAwayFromHome
Notes:
 #notes
For Office Use Only
Total Amount Due: ____________________

Deposit: _________ Receipt #: __________
Date: _____________

Balance Due: ______________

Balance Paid: ________________

Receipt # ________________
Date ______________
Registration requested submitted from #ipaddress on #registrationDate.
This printout generated on #date.