Camp Registration Form

Camper Information

Camper Status

New Camper
Returning Camper

First Name

Last Name

Suffix

Preferred Name

Gender

Pronouns

Date of Birth

Class

Shirt Size

Church/Youth Group

Current Address

Address Line 1

City

State

Zip Code

Parent/Guardian Information

Camper Lives With

Mother

Dad Suffix Name

Mom First Name

Mom Last Name

Mom Home Phone

Mom Mobile Phone

Mom Email

Father

Dad First Name

Dad Last Name

Dad Suffix

Dad Home Phone

Dad Mobile Phone

Dad Email

Guardian

Guardian First Name

Guardian Last Name

Guardian Suffix

Guardian Home Phone

Guardian Mobile Phone

Guardian Email

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.

Signature

Registration Email