CornerstonePiqua Youth Camp 2017 Registration

Camper's Information:

Full Name

Street Address:

City:

Going into grade:

Boy

Girl

Parent/Guardian:

Full Name:

Phone Number

Email Address

Please list any allergies, special medical concerns, physical limitations, or dietary restrictions:

T-Shirt Size

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Payment Information:

$98 per camper

Payment must be submitted before July 3rd

Make checks payable to CornerstonePiqua

Scholarships available (contact church office)

Questions: Contact CornerstonePiqua at 937-541-0042.

Success! You're registered for Youth Camp 2017.