Canal Point United Methodist Church

Summer Camp Forms for Riverside Retreat

Wonder-FULL!

Camper's Name*
If registering more than one child, please submit a different form for each child.
Street Address*
Address Line 2
City*
State / Province / Region*
Zip / Post Code
Country*
Mailing address
If different from above
Camper's Name as listed on name tag*
First Name
Last Name
Birthdate
Please include your child's birthdate
MM
/
DD
/
YYYY
Parent/Guardian Name*
First Name
Last Name
Your Email where confirmation will be sent*
Home Phone*
Parent/Guardian Cellular Phone*
Emergency Contact
First Name
Last Name
Emergency Phone

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Grade Completed as of June 2011
Describe any known medications taken and conditions your child may have:
Please include any allergies known
Please select the camp you wish to attend

Children's Camp is July 10th-16th
Jr. High Week is July 17th-23rd
Sr. High Week is July 24th-30th
Children's Week (Complete 2nd-4th grade)
Jr. High Week (Completed 5th-7th grade)
Sr. High Week (Completed 8th-12th grade)
Price per camper*
A $100 deposit per camper is required within one week of submitted application.
Check can be mailed to:
Riverside Retreat
7305 CR 78
LaBelle, FL 33935
Balance Due on camper arrival
Please indicate camper's name on check
T-Shirt Size*
Church Contact Person*
Title
First Name
Last Name
Suffix
Church Name*
Street Address*
Address Line 2
City*
State / Province / Region*
Zip / Post Code
Country*