Jr High Camper Registration FormPlease enable JavaScript in your browser to complete this form.1Camper Information2Parent Information3Credit Card InformationChurch Name *Pastor *Camper Name *FirstLastAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSchool Grage in Fall, 2019 *6th7th8th9thBirthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex *MaleFemaleBunk Buddy Request?YesNoBoth Campers must make request (Not Guaranteed) *Has camper attended our Camp before?YesNo# of years?What is the campers T-Shirt size?Any Special needs (notes & comments)?NextParent / Guardian Name *FirstLastAddress (if different than Campers)Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Daytime Phone *Home PhoneI release all photos, videos, and audio tapes of me/my child to the UMYC to be used for promotional purposes only *YesNoI would like to learn more about an area United Methodist ChurchYesNoPreviousNextPayment Amount *Minimum to RegisterPay Full AmountTotal$ 0.00Credit Card *Card NumberSecurity CodeName on CardExpirationMM123456789101112/YY2021222324252627282930PreviousEmailRegister Camper