Children's Camp 2021 Registration

June 21-25 | Please fill out this form and click submit.

For more information about this camp and to learn of Covid protocols they may implement, please go to www.centrikid.com

This camp is for students who have completed 3rd grade through 6th grade. Deposit of $60 must be paid to reserve your spot. Deposit is included in the total cost of $360.00. Limited number of partial scholarships are available upon request. Deadline to request a partial scholarship is April 1st. Camp will be at Austin College in Sherman, Texas June 21-25, 2021.

For more information about this camp and to learn of Covid protocols they may implement, please go to www.centrikid.com

Student / Sponsor Name

Grade Completed

Please select all that apply.

3rd 4th 5th 6th Teen Sponsor (16 & Up) Adult Sponsor

Gender

Please select all that apply.

Male Female

Phone

Address

Parent 1 First Name

Parent 1 Last Name

Parent 1 Phone

Parent 1 Email

This address will receive a confirmation email

Parent 2 First Name

Parent 2 Last Name

Parent 2 Phone

Parent 2 Email

This address will receive a confirmation email

Emergency Contact Information

Emergency Contact Name

Relationship to student

Emergency Contact Phone

Medical Information

Please download the following forms. Print each, complete, and return to Becky or the church office.

Medical Release/Permission Form (If you have completed this form during this calendar year, you do not need to resubmit it.)

CentriKid Participant (This form must be notarized.)

Allergies

Medications needed at camp

Medical or other information we need to know

TShirt Size

Please select one option.

Youth S Youth M Youth L Adult S Adult M Adult L Adult XL Adult XXL

Payment

Deposit must be paid to reserve your spot.

Payment

Deposit (60.00) Payment in Full (360.00) I would like to speak with Becky about a need-based scholarship ($0.00) I'm a camp sponsor ($0.00)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 21-25

Please fill out this form and click submit.

For more information about this camp and to learn of Covid protocols they may implement, please go to www.centrikid.com

Children's Camp 2021 Registration

Description

Please Fix the Following