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IMPACT YOUTH CAMP 2012 REGISTRATION
*Name:
*Home/Main Phone:
*Grade Finished (2011-2012):
*Home Address:
*City:
*State:
*Zip Code:
Date of Birth (MM/DD/YYYY):
*Emergency Contact & Phone Number:
Emergency Contact Relation to Camper:
Check box if you are a guest:
Roommate Preference (List 1 or 2):
*T-Shirt (adult size):
Health Insurance Co:
Health Insurance Policy Holder:
Insurance phone number:
List any allergies or medications:
By checking this box I understand my student & I must sign a Camp Covenant at the parent meeting on :
After submitting this form you will be directed to the PayPal site. If no payment is received this registration will be invalid.

PAY REMAINING BALANCE HERE
PayPal Balance - Tuesday, May 08, 2012

 

If you have previously registered online & need to pay your balance you can do so HERE without having to fill out the form again.

If you need to know your exact balance you can email Katie at Katie@rockwallyouth.org & she can get that to you.

 read more ...
PayPal Balance - Tuesday, May 08, 2012

 

If you have previously registered online & need to pay your balance you can do so HERE without having to fill out the form again.

If you need to know your exact balance you can email Katie at Katie@rockwallyouth.org & she can get that to you.

 read more ...
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FBC Rockwall Student Ministry - 610 South Goliad - Rockwall, TX 75087
469.698.2503 - info@rockwallyouth.org


 

 

 

FBC Rockwall Student Ministry - 610 South Goliad - Rockwall, TX 75087
469.698.2503 - info@rockwallyouth.org


 

 

 
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