FAMILY CAMP 2004 REGISTRATION FORM
Please list only those attending.
Head of Household: _____________________________________
Spouse: ______________________________________________
Address: _____________________________________________
City: ______________________Phone: _____________________
State: _____________________Zip Code: ___________________
E-mail address: ________________________________________
Children's Names Age & Grade in fall
1. _____________________
_______________
2. _____________________ _______________
3. _____________________ _______________
4. _____________________ _______________
5. _____________________ _______________
6. _____________________ _______________
Home Church: _____________________________________
Minister: _________________________________________
Accomodations desired: (Camp sites on first come, first served basis)
# in Men's dorm: ____ # in Women's dorm: _____ # in
Family Dorm: ____
RV/Camper____ Tent____ Motel
Unit/Suite _____
Do you need a site with water & electricity? _____
Other information:
1. Approximate time of arrival: ________ departure: ______________
2. Do you plan to stay for the area wide service? _________________
3. Does anyone in your family have special health requirements? _____
4. If yes, how can we help? ________________________________
____________________________________________________
____________________________________________________
5. What are you hoping will happen to your family as a result of a weekend
at Camp Epachiseca? _______________________________________
________________________________________________________
________________________________________________________