Registration Form

---

REGISTRATION FORM 4th, 5th, 6th grade HARTLAND JUNIOR WINTER CAMP February 1-3, 2019

Group Registration Fee: $180 (includes 2 nights and 6 meals)  Balance due in full by: 1/20/19 First Name: __________________________________

Last Name: ___________________________________

Gender: ___M

Date of Birth: _____/_____/_____

___F

Grade: __________

Street: _________________________________ City: ______________________________ Zip: ____________ Home Phone: (_____)_________________

E-MAIL ADDRESS*: ___________________________________ *Required—You will receive an e-mail from Hartland Camp requesting medical and insurance information.

CABIN ASSIGNMENTS: Coordinated by Hartland Camp Office. Limit Cabin Request to 2 campers only. They will try to honor your requests, but NO guarantee can be made. All requests must be registered with the Camp no later than 2 weeks prior to camp (1/20/19)

Name Request: _______________________________________

A $80 non-refundable deposit and this Registration Form must be turned into the Children’s Office or Church office (2525 S. Lovers Lane) to hold your child’s spot. Full payment is due by Sunday, January 20, 2019 (or earlier). Make check payable to Grace Community Church—note “JR. WINTER CAMP” 2525 S. Lovers Lane · Visalia, CA · 93292 ******************************************************** OFFICE USE ONLY: Paid: _____Deposit ($80.00) _____ Balance Pd ($100.00) _____ Full Payment ($180.00)

REGISTRATION FORM 4th, 5th, 6th grade HARTLAND JUNIOR WINTER CAMP February 1-3, 2019

Group Registration Fee: $180 (includes 2 nights and 6 meals)  Balance due in full by: 1/20/19 First Name: __________________________________

Last Name: ___________________________________

Gender: ___M

Date of Birth: _____/_____/_____

___F

Grade: __________

Street: _________________________________ City: ______________________________ Zip: ____________ Home Phone: (_____)_________________

E-MAIL ADDRESS*: ___________________________________ *Required—You will receive an e-mail from Hartland Camp requesting medical and insurance information.

CABIN ASSIGNMENTS: Coordinated by Hartland Camp Office. Limit Cabin Request to 2 campers only. They will try to honor your requests, but NO guarantee can be made. All requests must be registered with the Camp no later than 2 weeks prior to camp (1/20/19)

Name Request: _______________________________________

A $80 non-refundable deposit and this Registration Form must be turned into the Children’s Office or Church office (2525 S. Lovers Lane) to hold your child’s spot. Full payment is due by Sunday, January 20, 2019 (or earlier). Make check payable to Grace Community Church—note “JR. WINTER CAMP” 2525 S. Lovers Lane · Visalia, CA · 93292 ******************************************************** OFFICE USE ONLY: Paid: _____Deposit ($80.00) _____ Balance Pd ($100.00) _____ Full Payment ($180.00)