2022 TPBC 5th & 6th Grade Week
July 11 - 16, 2022
Camper First Name
*
Camper Last Name
*
Birth Date
*
-
Month
-
Day
Year
Date
Age
*
Grade in the fall
*
Sex
*
Please Select
Female
Male
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Camper Email
example@example.com
Other family members attending camp?
Please Select
No
Yes
Name of one other camper you would like to have as a cabin buddy.
New Camper
Please Select
No
Yes
Have you ever been a camper at Twin Peaks Bible Camp?
As a camper, I agree to obey all camp rules.
*
Please Select
Yes
Parent or Guardian Information
*
First Name
Last Name
Relation to camper
*
Parent or Guardian Address - if different from camp address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternate Email
example@example.com
Alternate Phone Number
Please enter a valid phone number.
Please give the name(s)and relation of anyone who should NOT pick up your child from camp. Please provide current custody papers to verify.
Please give us the name, address, and phone number of anyone you have given permission to pick up your child at camp, if you are unable to do so.
I authorize my child to participate in all special trips or hikes away from camp.
*
Please Select
Yes
No
I give permission for Twin Peaks Bible Camp to use any pictures taken of my camper at camp on any promotional material or the camp website.
*
Please Select
Yes
No
Please excuse my child from these physical activity during the camp week.
Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Payment
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( X )
Deposit
Receive $50 off the regular registration fee if received by May 1, 2022. (Choose either Deposit or Camp Fee, don't select both)
$
40.00
Camp Fee
This is the discounted camp cost if registration is received by May, 2022. (Choose either Deposit or Camp Fee, don't select both)
$
250.00
Submit
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