Name *

First Name

Last Name

Primary Phone Number *

(###)

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Birth date *

MM

DD

YYYY

Gender *

Female

Male

Applying for... *

JR & JR Teen Camp: July 8-13

Teen Camp: July 1-6

Which would you describe yourself as... *

A morning person

A night owl

Either

What activities would you be interested in leading? *

Water front

Kayaking

Crafts

Drama

Games

Worship

Sharing of testimony

Other

Reference *

Please refer someone we can contact.

First Name

Last Name

Phone *

(###)

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