Camper Pre-Registration 2022

First Name *

Last Name *

Address *

City *

State *

ZIP *

Camp Week *

Sr High (Grades 9-12) June 5 - 10

Jr High (Grades 6-8) June 12 - 17

Junior (Gardes 3-5) June 19 - 23

Day Camp (Grades 1-2) June 25 (Saturday)

Beloved Camp (Grades 7-12, Girls) July 9 - 10

Deeper Life (Grades 7-12) July 10 - 15

Multiple Weeks:Multiple Weeks:

Birth Date *

Home Church

Camp T-Shirt size * Child Medium Child Large Adult Small Adult Medium Adult Large Adult X-Large

Email of parent or guadian: (confirmation notice will go to this address.) *

2022 Camper Pre-Registration Fee $25.00 *

Pay now with PayPal (Includes service charge)

Pay by Mail-in Check

Total

Total to PayPal

Total to Pay by Mail-in Check

Full Registration Form and Balance of Fee must be presented at check-in or earlier. Thanks. Mailing address: MLCC Registration, P.O. Box 188, Horton, KS 66439

Emergency Contact Name

(First, Last Name)

Emergency Contact Number

Telephone Number (xxx) xxx-xxxx

Additional comments

(arriving late, leaving early, etc.)

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