2023 Camp Online Registration | Pioneer Ministries

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2024 Summer Camp
Golf Fundraiser
About
- History
Apply
Contact

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Camp Registration

Camper Name(Required)

First Last

Which Week Will You Attend?(Required)

Week 1 (No more boys accepted, only girls)

Week 2 (No more girls accepted, only boys)

Week 3

Week 4

NOTE: Week 5 is completely full.

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Gender at Birth(Required)

Age at time of camp?(Required)

Birthdate(Required)

T-Shirt Size(Required)

S

M

L

XL

2XL

List activities/special interests(Required)

Special Request or Need(Required)

Parent's Name(Required)

First Last

Parent's Phone(Required)

Other Emergency Contact(Required)

First Last

Phone(Required)

Home Church(Required)

Pastor(Required)

First Last

I give my permission for pictures of my child during camp to be used for publicity(Required)

Yes

No

Any known health problems?(Required)

Approximate Date of Last Tetanus Shot(Required)

Regular Medications(Required)

Activity Restrictions(Required)

Bed Wetting at Present Time?(Required)

Yes

No

Accident/Health Insurance Carrier(Required)

Insurance Policy #(Required)

Parent Signature(Required)

PARENT’S AUTHORIZATION (Please read and sign) “I hereby give permission for the above name camper to participate in all Camp Pioneer’s camping activities (except as noted above) and for Camp Pioneer to authorize any hospital/medical treatment deemed necessary by a qualified physician for my child. Camper’s gender indication must match birth gender.

Student Signature(Required)

2023 Pioneer Ministries Inc.