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INSTRUCTIONS

  1. DO NOT LEAVE ANY ANSWER SPACE BLANK - if you don't know an answer, just type none. Except for the "Comments", all other blank answers will cause the application to be rejected.

  2. Use your mouse or the tab key to go from field to field.
    DO NOT USE THE ENTER KEY. Click on "Submit Form" with your mouse when the form is completely filled out.

  3. Check your form for accuracy. Take your time, read slowly, and fill in all the blanks. (It is faster to be slow and thorough (completing it correctly) than having to submit another application.

  4. Thank you for registering online.

Camper Registration

Regular Campers must be 11 years old by Oct. 1 of the camp year.

Regular Camper Fee is $90.00
Day Camp Fee is $40.00
High School Retreat Fee is $25.00

If submitting application via this website,
registration will be on hold until $10.00 registration fee is received.

  • Camper Information:

    First Name
    Last Name
    Gender Male Female
    Date born (example: 07/10/1995 for July 10, 1995)
    Age
    Next School
    Grade?         		2nd, 3rd, 4th, 5th, 6th, 7th, 8th,
    9th, 10th, 11th, 12th, Graduated

  • Contact Information:

    Parents Full Name
    Street address
    City
    State/Province
    Zip/PostalCode
    Home Phone
    Cell Phone
    Work Phone
    E-mail

  • Choose the camp week you desire to attend:

    NOTE: (see below)
    Only those camp weeks which are open for additional campers are shown.

    CW9, July 27-Aug 2, Rodney Pless, is now FULL and CLOSED.


    Camp Week (CW)
    -CW8, July 20-26, Wayne Deffenbaugh / Jon Hendrix
    Day Camp (DC)
    -DC4, July 28-31, Rodney Pless
    High School Retreat (HSR)
    -HSR, Sept 5-7, Marshall Brown

  • Church Preference:  
    Church Home: 
    Church Address: 
    Church City: 
    Church State: 
    Church Zip: 
    Has camper been baptized? Yes No
    Comments:


  • Your Medical Insurance Company: 
    Policy or Group No.: 
    Please list any allergy or medical information that we should know about?

    Note to Parents:  By submitting this application you are authorizing Green Valley Bible Camp to see that the applicant is taken to a doctor or hospital for emergency treatment in the event of an accident or injury while attending camp.  You also agree that Green Valley Bible Camp, its directors, trustees, officers, or attendants will not be held legally responsible for such accident or injury.

Last revised:
June 23, 2008