O.D.C. CHILDREN FOR CHRIST CAMP – JULY 22-27, 2012

REGISTRATION FORM

OHIO DISTRICT COUNCIL HALLOWED HILLS CAMPGROUNDS

3129 East Pike Zanesville, Ohio 43701

CAMPDIRECTORS : Dr. D. W. Cummings & Minister Melanie Cummings - 118 East Cardinal Street Wheeling, WV 26003

Phone: (304) 233-7270 Fax: (304) 233-2460 E-Mail: Website:

The Ohio District Council Children for Christ Camp accepts all children ages 4/Pre-School through Grade 6 (this coming Fall school grade)

regardless of race, creed, color or ethnic background.

PLEASE NOTE: THE CHILDREN FOR CHRIST CAMPREGRETS THAT WE ARE NOT ABLE TO SERVICE CHILDREN WITH SPECIAL PHYSICAL AND MENTAL NEEDS DUE TO THE LACK OF STAFFING, FINANCES AND LIABILITY COVERAGE. IT IS OUR PRAYER THAT IN THE FUTURE, WE WILL BE ABLE TO SERVICE SPECIAL NEEDS KIDS. WE DO RECOMMEND, HOWEVER THAT PARENTS SEARCH THE INTERNET AND OTHER RESOURCES FOR CAMPPROGRAMS SPECIALLY DESIGNED FOR CHILDREN WITH SPECIAL NEEDS.

PLEASE PRINT AND COMPLETE THE FOLLOWING REGISTRATION INFORMATION.

CAMPER’S NAME ______M ______F ______

ADDRESS______

CITY/STATE/ZIPCODE______

T-SHIRT (CIRCLE 1): CHILD SIZES: SMALL, MEDIUM, LARGE, XLARGE - ADULT SIZES: SMALL, MEDIUM, LARGE, XLARGE

PARENTAL PERMISSION FOR WATER BAPTISM (Read & sign only once): I, ______, hereby authorize permission for my child, ______, to be baptized in the name of Jesus if they choose to, according to Acts 2:38 during his/her stay at the Ohio District Council Hallowed Hills Campground during July 22-27, 2012.

OR Sign here:______if your child has ALREADY been baptized in Jesus name.

OR Sign here:______if your child has not been baptized & DOES NOT have permission to be baptized

BIRTHDATE ______HOME PHONE ______FALL 2011 SCHOOL GRADE  PreK  1st

PARENT/GUARDIAN______2nd  3rd 4th  5th 6th

EMAIL:______CELL PHONE: ______

CHURCH ______PASTOR ______

IN CASE OF EMERGENCY…

NAME______PHONE______

NAME______PHONE______

EARLY BIRD REGISTRATION: CAMPFEE $95.00/ CAMPER IF POSTMARKED BY APRIL 15, 2012.

TUITION: The general tuition for campers is $100.00. Senior Citizen tuition is $75.00.

Please check the tuition fee that applies to this applicant:

Scholarship Amount: $______Provided by: ______

Early-Bird Camper Tuition Fee - $95.00  Camper Tuition - $100.00

Cash Enclosed  Money Order Enclosed  Internet Payment-Pleaseattach copy of receipt

Senior Citizen Tuition - $75.00

NOTE: TO GUARANTEE ADEQUATE MATERIALS FOR EACH CAMPER, ALL TUITION REGISTRATION FEES WILLBE & MUST BE PRE-PAID.

EARLY BIRD REGISTRATION NEEDS TO BE POSTMARKED BY APRIL 15, 2012 ($95.00)

THE DEADLINE FOR REGULARREGISTRATION IS JUNE 1, 2012. ($100.00) .

FINAL DEADLINE WILL BE JUNE 2 - JULY 7, 2012. ($125.00)

ALL REGISTRATION FEES MUST BE PAID WITH A CASHIER’S CHECK, MONEY ORDER OR CASH.

NO PERSONAL CHECKS ACCEPTED. MAKE CASHIER’S CHECK OR MONEY ORDER

  • PAYABLE TO: O.D.C. CHILDREN FOR CHRIST CAMP
  • & MAIL TO: ODC C4C CAMP, Minister M. Cummings, 118 East Cardinal Street, Wheeling, WV26003