Nutterville Apostolic Church

Online Application

*Campers Name *Mailing Address AND PHONE NUMBER( EMAIL IF YOU HAVE ONE )
*AGE ( as of June 21) *Emergency Contact 1 *Phone Number *Emergency Contact 2 *Phone Number *Allergies ( If none you must write NONE)
*Special Conditions ( If none you must type NONE)
*Medication: Include Time, Dosage and Instructions ( IF NONE YOU MUST TYPE NONE)
*Would you like to purchase a camp T-Shirt for $ 8.00 ( Parents pay for shirts when you sign campers in)
Yes
No
I can not afford one at this time
*Would you like to Purchase a camp photo for $ 4.00 ( Parents pay for photos when you sign the camper in)
yes
no
I can not afford one at this time
*Please select a T-shirt size,( even if you did not want to order one.)
Child Small
Child Med
Child Large
Small
Med
Large
XLarge
XXLarge
3 XLarge
4XLarge
5XLarge
*Please list the people who are allowed to pick up your child from camp. Please note: IF A PERSON IS NOT ON THIS LIST WE WILL NOT RELEASE YOUR CHILD

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