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July
11 16, 2010 DEAF CHRISTIAN CAMP APPLICATION
(For each Youth and Adult campers and Staff)
(One
Form Per Person Please, You may make more
copies of this form for more campers if
necessary)
NAME:
______________________________________ Birth
Date: _______________
ADDRESS:
_________________________________________
Age____ Sex _____
CITY:
_________________ STATE: ___ ZIP CODE:
___________
PHONE:
(___) ____ ______ BUSINESS: ( ) _____ ______
S.S.N. # _____ ____ _____
CHURCH AFFLIANT:
______________________________________
______________ ________
Name of Congregation
City
State
(Circle One) DEAF/HH/HEARING
QUESTIONS FOR PARENTS/GUARDIANS OF YOUTH
CAMPERS (AGE 9 18):
*IF YOUR YOUTH CAMPER WANTS TO BE BAPTIZED,
MAY HE OR SHE DO SO?
___________________________________________________________________________________
Parents/Guardians name(s):_____________________________________________________________
Grade as of Fall 2010:_____________________
CAMPER’S AGREEMENT: (Every Youth and
Adult camper and Staff must sign)
“I agree to abide by all of the rules and
policies of Deaf Christian Camp/Quartz
Mountain Christian Camp.”
SIGNED_______________________________________________________
DATE: ______________
CHECK YOUR PAYMENT: (All checks and
money order payable to DEAF CHRISTIAN CAMP)
____1) Enclosed is $155.00 per adult camper
for entire camp fee if sent on or before
June 15, 2010.
____2) Enclosed is $145.00 per youth camper
for entire camp fee if sent on or before
June 15, 2010.
____3) Enclosed is $165.00 per adult camper
for entire camp fee if sent after June 15,
2010.
____4) Enclosed is $155.00 per youth camper
for entire camp fee if sent after June 15,
2010.
____5) Enclosed is the non refundable and
non transferable registration fee of $75.00
per adult or youth camper if sent on or
before June 15, 2010, (After the deadline,
the adult camper fee of $165.00 or youth
camper fee of $155.00 have to be paid, in
this case go to #3 and #4). The balance of
adult camper is $80.00 or youth camper is
$70.00 to be paid on the first day of camp.
____ 6) Scholarship (for youth only) or
Family Rate. Either one is applicable only
on or before the deadline, June 15, 2010.
(Check the director first before mailing
this form).
PAYMENT ENCLOSED: $____________
BALANCE TO PAY ON JUNE 15, 2010:
$______________
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