Chalice Camp Registration

First Unitarian Church
600 NW 13th Street
Oklahoma City, OK 73103
T: 405-232-9224
F: 405-232-3843

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Chalice Camp 2013 Registration

Chalice Camp 2013 - First Unitarian Church of Oklahoma City

Monday, June 3rd through Friday, June 7th

* denotes required fields

Camper 1

Camper 1 :: Camper 1

Camper 1 Date of Birth (yyyy/mm/dd format)

Camper 1 Date of Birth (yyyy/mm/dd format) :: Camper 1 Date of Birth using this format yyyy/mm/dd.

Camper 1 Grade in September

Camper 1 Grade in September :: What grade will Camper 1 be in come September?

Camper 1 T-shirt Size

Camper 1 T-shirt Size :: What size t-shirt does Camper 1 wear?

Camper 2

Camper 2 :: Name of Camper 2

Camper 2 Date of Birth (yyyy/mm/dd format)

Camper 2 Date of Birth (yyyy/mm/dd format) :: What is Camper 2's birthdate (using this format yyyy/mm/dd)?

Camper 2 Grade in September

Camper 2 Grade in September :: What grade will Camper 2 be in come September?

Camper 2 T-shirt Size

Camper 2 T-shirt Size :: What size t-shirt does Camper 2 wear?

Jr. Counselor

Jr. Counselor Date of Birth (yyyy/mm/dd format)

Jr. Counselor Date of Birth (yyyy/mm/dd format) :: What is Jr. Counselor's birthdate (using this format yyyy/mm/dd)?

Jr. Counselor Grade in September

Jr. Counselor Grade in September :: What grade will Jr. Counselor be in come September?

Jr. Counselor T-shirt Size

Jr. Counselor T-shirt Size :: What size t-shirt does Jr. Counselor wear?

*Parent's Name (s)

*Parent's Name (s) :: Enter parent(s) name(s) here (REQUIRED)

*Parent's Address (s)

*Parent's Address (s) :: Enter Parent's Address (REQUIRED)

*Email Address

*Email Address :: This email address will only be used for purposes of camp registration (REQUIRED)

Phone Numbers (Enter at least one)

Home(s)

Work(s)

Cell(s)

*Emergency Contact

*Emergency Contact :: Please enter an emergency contact (REQUIRED)

*Relationship

*Relationship :: Emergency contact's relationship to camper (REQUIRED)

*Emergency Contact Phone

*Emergency Contact Phone :: Emergency contact's phone number (REQUIRED)

Allergies or physical reactions (insect bites, poison ivy, etc.)

Medication to be given during camp (Time)

Medication to be given during camp (Time) :: Please list medications needed to be taken at camp and at what time

Fee Schedule:

Members $110

Guests $150

*Amount To Be Paid ($)

*Amount To Be Paid ($) :: Total Amount Due (REQUIRED)

(Additional campers in a family $10 less)

Childcare needed before and/or after camp?

AM
PM

Childcare needed before and/or after camp? :: Check box if you need childcare in morning and/or afternoon

*Transportation to be used

Church Bus
Car

*Transportation to be used :: How will your camper get to/from camp? (REQUIRED)

I release the First Unitarian Church of Oklahoma City and staff members of all claims beyond current insurance coverage. I grant permission for my children to receive first aid treatment if required.

*Parents Digital Signature

*Parents Digital Signature :: Please enter parent's name here (REQUIRED)

*Signature Date

*Signature Date :: Please enter signature date (REQUIRED)

I can be an adult counselor on

Monday
Tuesday
Wednesday
Thursday
Friday

Comments:

Comments: :: Enter any comments here

*Validation

*Validation :: Enter the characters as they appear in the box.