Summer Camp Registration

This form can be used to register up to 3 campers as long as they are attending the same camp days and share the same parent information

Camper One Name *

First

Last

Camper One Age *

Camper One Additional Information *

Please use this section to let use know about any allergies and/or medical conditions camper ONE may have.

Camper Two Name

First

Last

Camper Two Age

Camper Two Additional Information

Please use this section to let use know about any allergies and/or medical conditions camper TWO may have.

Camper Three Name

First

Last

Camper Three Age

Camper Three Additional Information

Please use this section to let use know about any allergies and/or medical conditions camper THREE may have.

Digging for Dinosaurs ________________________ Avengers Assemble! _________________________ Camp Out

ROAR! Life is Wild, God is Good ______________ Party in the USA _____________________________ Splashtacular

Adventures under the Sea ___________________ Safari Spectacular ____________________________ The Greatest Show

Fabulous Fair

Parent Name *

First

Last

Parent Email *

Parent Phone Number *

Parent Address *

Address Line 1

City

State

Zip Code

TERMS & CONDITIONS: *

By checking this box you acknowledge that you have read the following: Photographs, audio tapes or video tapes of me and/or my child may be taken by members of Good Samaritan UMC Faculty and Staff before, during or after camps while at Good Samaritan Camps. Said materials may be used for promotional purposes including newspaper, web site, advertising and other purposes for Good Samaritan UMC. Furthermore, I hereby consent that such information, sound, photographs, videos and files from which they are made shall be the property of Good Samaritan UMC. No names of students will appear on publicity.

Checkboxes *

By checking this box you acknowledge that you have read the following: I will make payment by check/money order made out to "GSUMC" or by cash. I understand that all camp fees are due no later than the Friday before the camp week that is to be attended and that any payment received after the Friday prior to camp attendance will be subject to a late fee.

Checkboxes *

By checking this box you acknowledge that you have read the following: I understand that by registering online I am committing to making payment of the entire camp tuition. Should I wish to withdraw from camp, I understand that a WITHDRAWAL FORM must be submitted to Good Samaritan UMC, and that my withdrawal will take 15 business days to complete. Therefore, I will be liable for any tuition payments that are due within those 15 days.

Checkboxes *

By checking this box you acknowledge that you have read the following: I understand that each camper will be charged a $40 registration fee and this fee is non-refundable regardless of the camper’s attendance.

Single Line Text *