2023 STAFF Registration Form

1General Information > 2Emergency Contact Information > 3Medical Information > 4Application Information
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
D.O.B. D.O.B. / MM / DD YYYY
Gender
Church you attend
Select the Camp (s) that you are applying to help at: (select all that apply)

Select the Camp (s) that you are applying to help at: (select all that apply) Camp IMPACT (July 8-12) Grades 6-12
Camp ADVENTURE (July 12-15) Grades K-5
I'm applying to be a:

I'm applying to be a: Counselor Worker/Helper