SSCYC, INC.

"A Vacation with a Purpose"

SUMMER CAMP REGISTRATION FORM

CAMP INFORMATION

Dates	August 17-23, 2024
Location	Camp Cody
	9 Cody Road
	Freedom, NH 03836
	800-399-4436 or 603-539-4997

CAMPER INFORMATION

Full Name

First Name Last Name Suffix

Nickname

This should be the name your son/daughter usually goes by.
It will be used on all of our camp lists. (Ex. John might go by Jack, etc.)

Gender

Address

Street Address

City State Zip Code

Date of Birth

MM/DD/YYYY

Class/Grade
(as of Jan. 1, 2024)

T-shirt Size
(Adult Sizes)

Church/Youth Group

If your family is a member of one of the churches, yet your child attends Youth Group at another church, please select the church of which you and your family are members.

PARENT/GUARDIAN INFORMATION

Camper Lives With

Mother's Contact Information

First Name Last Name

Do you wish to receive camp notification emails?

Father's Contact Information

First Name Last Name Suffix

Do you wish to receive camp notification emails?

Guardian's Contact Information

First Name Last Name Suffix

Do you wish to receive camp notification emails?

PARENT'S OR GUARDIAN'S STATEMENT

By registering this camper, I give my permission for photographs, video or live screen captures of this camper to be used by SSCYC, Inc. in publications, websites, videos, blogs, Facebook, online photo sharing, etc.

REGISTRATION SUBMISSION

Please type your name below and review your digital signature.

Print your name Date Registration email address
Signature

Upon clicking "Submit Registration" you will be taken to a confirmation page and a copy of the registration will be sent to the registration email address provided above.