To secure a space, please be sure to include registration fee of $35 with this application and return to Finance Office.
Name of Participant*
Date of Birth*
Age*
Sex*
Home Address*
City*
State*
Zip*
Home Telephone Number
Cell Number*
Name of Parent or Legal Guardian*
E-Mail Address*
In Emergency, we may call*
Relationship to Camper*
Telephone Number*
Cell Phone Number
Greater Community Church of God in Christ * 406 Roswell Street * Marietta, GA 30060 * 770-590-8510, ext. 18