Registration Options

Counselor
Service
Safety

Name

Phone Number

Address

Gender

Male
Female

Date of Birth

HOW MANY YEARS OF CHURCH ATTENDANCE?

CHURCH ATTENDANCE FREQUENCY

I ACKNOWLEDGE that Junior Counselors must be 22 years old, and Senior Counselors must be 25 years old

PASTOR INFORMATION

PASTOR

PASTOR'S FIRST/LAST NAME (if not mentioned above)

CHURCH NAME

CITY OF CHURCH

PASTOR OR CHURCH PHONE

PASTOR'S EMAIL

I AFFIRM THE ABOVE INFORMATION TO BE TRUE, AND AS THE STATED INDIVIDUAL WILL ABIDE BY ALL CAMP REQUIREMENTS UPON APROVAL AS STAFF OF CAMP WEST

Signature

By signing below you are agreeing to the Camp Guidelines, you acknowledge that both yourself (as the authorized registrant) and the participant (staff or camper), which maybe the same person, agree that the camper will follow the CAMP WEST guidelines specified in the Camp West Guidelines Document found on the website.

I, the undersigned, agree to the terms above.

STAFF INFORMATION

PASTOR INFORMATION

TIME UNTIL EARLY REGISTRATION ENDS:

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TIME UNTIL CAMP WEST BEGINS:

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Almost done, where should we send the confirmation?