Camper Registration Form Please 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 Grade (in Fall, 2022) *Birthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex *MaleFemaleHas the camper attended a United Methodist Camp before?YesNo# of years?What is the camper's T-Shirt size?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. In signing this document, I give permission for my child to have access to Zoom, MyCourses (the on-line learning platform), videos and websites. Login information will be provided to the email provided on the course registration form. Access of Zoom is password protected and participants, guardians and instructors will be allowed access. *YesNoI would like to learn more about an area United Methodist ChurchYesNoPreviousNextPayment AmountPay AmountNo reimbursementsTotal$ 0.00Credit Card *Card NumberSecurity CodeName on CardExpirationMM123456789101112/YY2324252627282930313233PreviousEmailRegister Camper
