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Children’s Programming: 10:30am
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I’m New
Connect
About Us
Staff
Beliefs
Heritage
Preschool
Ministries
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Youth
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Missions
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Worship Arts
Resources
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Library
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Camp Registration
Please enable JavaScript in your browser to complete this form.
Primary Contact Info
-
Step
1
of 8
Primary Contact Info
(Parent/guardian creating the registration)
Name of Primary Contact
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
Primary Contact Phone Numbers (enter up to 3)
*
Phone Number
Phone Number
Next
Emergency Contact Info
Emergency Contact Full Name
*
First
Last
Emergency Contact Phone Number
*
Secondary Emergency Contact Full Name
First
Last
Secondary Emergency Contact Phone Number
Previous
Next
Pediatrician's Info/Camp Agreement
Pediatrician's Name
*
First
Last
Pediatrician's Phone Number
*
Pediatrician's After-Hours Phone Number
CCC Camp Agreement
I recognize that camp involves outdoor activities and that an injury to my child may be sustained. The child(ren) listed on this form has/have my permission to attend the CCC Camp indicated by this registration. In the event that medical treatment is necessary, every effort will be made to contact me. If I cannot be reached, I give permission to camp staff to secure the services of a licensed physician to provide the care necessary for my child's well-being and agree to pay the charges for such. The camp cost will be refunded if cancellation is received one month prior to the start of camp. There will be no refunds beyond this date except in the event of illness. In the event of illness, notice must be received no later than the first day of camp at 9:00am.
Acknowledge
*
I agree with these terms
Previous
Next
Camper Info 1
Camper's Name
*
First
Last
Camper's Gender
*
Male
Female
Parents'/Guardians' Full Names
Camper's Age (as of camp)
*
Grade Entering this Fall (if applicable)
*
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
T-shirt Size
*
Youth X-Small (2-4)
Youth Small (6-8)
Youth Medium (10-12)
Youth Large (14-16)
Adult Small
Adult Medium
Adult Large
Adult X-Large
Group/Cabin Buddy Request
Preo Overnight: If registering for Camp Preo and entering grade 1 or 2, will your camper attend our special overnight camp experience on the Wednesday night of camp?
Yes
This child may receive the following medications if needed:
Tylenol
Ibuprofin
Benadryl
Dramamine
Does this child get carsick?
*
Yes
No
Special Medical or Dietary Needs
Permission to Use Likeness: As a parent/guardian, I give CCC permission to use image(s) of this child in future advertising (brochures, website, etc.)
*
Yes
No
Previous
Next
Camper Info 2
Register a 2nd camper?
*
Yes
No
Camper's Name
*
First
Last
Camper's Gender
*
Male
Female
Parents'/Guardians' Full Names
Age (as of camp)
*
Grade Entering this Fall (if applicable)
*
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
T-shirt Size
*
Youth X-Small (2-4)
Youth Small (6-8)
Youth Medium (10-12)
Youth Large (14-16)
Adult Small
Adult Medium
Adult Large
Adult X-Large
Group/Cabin Buddy Request
Preo Overnight: If registering for Camp Preo and entering grade 1 or 2, will your camper attend our special overnight camp experience on the Wednesday night of camp?
Yes
This child may receive the following medications if needed:
Tylenol
Ibuprofin
Benadryl
Dramamine
Does this child get carsick?
*
Yes
No
Special Medical or Dietary Needs
Permission to Use Likeness: As a parent/guardian, I give CCC permission to use image(s) of this child in future advertising (brochures, website, etc.)
*
Yes
No
Previous
Next
Camper Info 3
Register a 3rd camper?
*
Yes
No
Camper's Name
*
First
Last
Camper's Gender
*
Male
Female
Parents'/Guardians' Full Names
Age (as of camp)
*
Grade Entering this Fall (if applicable)
*
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
T-shirt Size
*
Youth X-Small (2-4)
Youth Small (6-8)
Youth Medium (10-12)
Youth Large (14-16)
Adult Small
Adult Medium
Adult Large
Adult X-Large
Group/Cabin Buddy Request
Preo Overnight: If registering for Camp Preo and entering grade 1 or 2, will your camper attend our special overnight camp experience on the Wednesday night of camp?
Yes
This child may receive the following medications if needed:
Tylenol
Ibuprofin
Benadryl
Dramamine
Does this child get carsick?
*
Yes
No
Special Medical or Dietary Needs
Permission to Use Likeness: As a parent/guardian, I give CCC permission to use image(s) of this child in future advertising (brochures, website, etc.)
*
Yes
No
Previous
Next
Camper Info 4
Register a 4th camper?
*
Yes
No
Camper's Name
*
First
Last
Camper's Gender
*
Male
Female
Parents'/Guardians' Full Names
Age (as of camp)
Grade Entering this Fall (if applicable)
*
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
T-shirt Size
*
Youth X-Small (2-4)
Youth Small (6-8)
Youth Medium (10-12)
Youth Large (14-16)
Adult Small
Adult Medium
Adult Large
Adult X-Large
Group/Cabin Buddy Request
Preo Overnight: If registering for Camp Preo and entering grade 1 or 2, will your camper attend our special overnight camp experience on the Wednesday night of camp?
Yes
This child may receive the following medications if needed:
Tylenol
Ibuprofin
Benadryl
Dramamine
Does this child get carsick?
*
Yes
No
Special Medical or Dietary Needs
Permission to Use Likeness: As a parent/guardian, I give CCC permission to use image(s) of this child in future advertising (brochures, website, etc.)
*
Yes
No
Previous
Next
Payment/Scholarship
We have never turned a camper away because of cost. You can request a full or partial scholarship on our registration form. All scholarship requests will be honored.
Camper #1 Payment
Preo full payment - $ 140.00
Preo half scholarship - $ 70.00
Camp O full payment - $ 240.00
Camp O half scholarship - $ 120.00
Camper #1 Full scholarship
I request a full scholarship for this camper
Camper #2 Payment
Preo full payment - $ 140.00
Preo half scholarship - $ 70.00
Camp O full payment - $ 240.00
Camp O half scholarship - $ 120.00
Camper #2 Full scholarship
I request a full scholarship for this camper
Camper #3 Payment
Preo full payment - $ 140.00
Preo half scholarship - $ 70.00
Camp O full payment - $ 240.00
Camp O half scholarship - $ 120.00
Camper #3 Full scholarship
I request a full scholarship for this camper
Camper #4 Payment
Preo full payment - $ 140.00
Preo half scholarship - $ 70.00
Camp O full payment - $ 240.00
Camp O half scholarship - $ 120.00
Camper #4 Full scholarship
I request a full scholarship for this camper
Total
$ 0.00
Submit Your Registration
After clicking the Submit button below, you will be directed to PayPal for payment. Please complete payment at this time--there is NOT a way to return to this page later on. If you don't see a registration confirmation email after completing your registration, please check your spam/junk mail folder.
Submit/Proceed to Payment