2023 Camp Online Registration | Pioneer Ministries

Skip to content

Home
2023 Summer Camp
2023 Golf Outing
About
- History
Resources
- Employment
- Newsletter
Contact

Menu

Home
2023 Summer Camp
2023 Golf Outing
About
- History
Resources
- Employment
- Newsletter
Contact

DONATE

Camp Registration 2023

Camper Name(Required)

First Last

Which Week Will You Attend?(Required)

Week 1

Week 2

Week 3

Week 4

Week 5

Address(Required)

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

Phone(Required)

Email(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.