Camp Registration Form

*Camper's First Name:	Last Name:
*Gender	*Age at Camp Grade Completed
*Birth Date	(mm/dd/yyyy)

*Street Address
*City	State Zip

Church Name:
Pastor's Name:

Parent/Guardian Name:
*Home Phone	(111-111-1111)
Cell / Daytime Phone	(111-111-1111)
When calling ask for
*E-mail

First Choice of Camp
Second Choice of Camp

Cabin Mate Request

First time away from home?
Attended Camp Swatara before?

Does the camper have any special medical, emotional or dietary needs that we should be aware of prior to camp? If so, please describe briefly:

For security, please enter the letters and numbers you see to the left:

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Please be patient after clicking submit as it may take the system up to 30 seconds to process your request