Page 8 - index

2014 SUMMER CAMP REGISTRATION FORM

Now ofering online registration! www.sugarcreekbiblecamp.org

Sugar Creek is an ELCA 2014 SUMMER CAMP REGISTRATION FORM
Lutheran afliated camp.
Last Name ____________________________ First _________________  Boy  Girl FOR OFFICE USE ONLY
Address ________________________________________________________________ Code # _____________
CC # _______________
City _______________________________ State ________ Zip ______________
Cost ________________
SUMMER REGISTRATION Grade in Sept. ’14 _______________ Graduation Year ________ Disc. ________________
Dept. _______________
Birthdate ______________________ Current Age ___________
BD _________________
Parents’ Names __________________________________________________________________________________
Home Phone ____________________________________________________________________________________
Cell Phone Number: Mom _____________________________ Dad _______________________________________
Parents’ E-mail __________________________________________________________________________________
Parents' Work Phone: Mom ____________________________ Dad _______________________________________
NOT FOR FAMILY EVENTS OR RETREATS REGISTRATION! SEE PAGE 15!
In Case of Emergency, call (other than above) ___________________________________________________________
Church Name & Town _____________________________________________________________________________
Insurance Company Name _________________________________ I.D ___________________________________
Address (Family Insurance - First Carrier) _________________________________________________________________
I AM REGISTERING FOR: (check one)
 Pilgrims ....................................$200  Horse Camp ............................$370  Riverboaters ............................ $415
 Seekers .....................................$370  Confrmation Camp .............$370  SIT-LIT ...................................... $400
 Pathfnders ..............................$370  Theatre Camp ........................$370  Hands On! ................................$200
 Wagoneers ..............................$370  Junior Wranglers ..................$370  Backwoods Bike ...................$370
 Discoverers .............................$370  Pedal & Paddle ......................$370  Many Hands ............................$370
 Settlers .....................................$370  Voyageurs ...............................$370  Rockin' The Creek* ..............$340
 Art Camp .................................$370  Up North ..................................$370 (*SIT-LITs may attend for free)
A deposit of at least $70 is required when you register or you are welcome to pay in full now. Deposits and payments are
refundable until June 1, 2014, after that date we retain the deposit. We do not register by phone. After you register, you will
receive a health form, camper list, profle sheet, and directions to camp. These forms are also available on our website.
 Check here if you prefer to receive your receipt and forms by e-mail.
Please add kati@sgrcreek.org and camp@sgrcreek.org to your list of approved senders.
Please list the week(s) of camp you would like to attend in order of preference:
1st Choice: _______________________ 2nd Choice ______________________ 3rd Choice ______________________
Cabinmates requested* Please indicate if cabinmate is New to camp to receive a free t-shirt!
Cabinmate: ________________________________ Cabinmate: _______________________________
*Cabinmates must mutually request one another. Each camper may request only 2 cabinmates. High School of-site programs are the
exception to this policy.
MAIL completed form with at least a
Credit Card Payment Option: (All credit card transactions are subject to a 3% surcharge.)
Type of card: Visa Mastercard Discover Amount to charge: $_________** $70 deposit to:
Card # ____________________________ Exp. Date __________ CV2# _________ SUGAR CREEK BIBLE CAMP
Cardholder's Name (printed)__________________________________________ __ 13141 Sugar Creek Bible Camp Rd.
Ferryville, WI 54628
Cardholder’s Signature _________________________________________________ FAX with credit card information:
**Please consider a donation to this ministry. Although most tuition fees are $370, 608-734-3601
the actual cost per camper is well over $500 per week. We depend upon donations
to make up the diference. Thank you. Or register on-line at:
I would like to make a tax-deductible donation of: $____________ to help ofset the cost of camp. www.sugarcreekbiblecamp.org
Photocopy this form if needed

8 13141 SUGAR CREEK BIBLE CAMP RD. • FERRYVILLE, WI 54628 • 608-734-3113 • WWW.SUGARCREEKBIBLECAMP.ORG We love because He first loved us! – 1 John 4:19

7099_Program.indd 8 12/13/13 10:43 AM