(Please fill out both sides completely and supply necessary signatures…thanks!)
Last Name:
First Name:
Home Address:
Gender: M F
City:
Home Phone:
Age:
Birthdate:
Grade Next Fall:
State:
Zip:
Email Address:
T-Shirt Size: (circle one)
Middle School Camp (July 6-10) - Grades 6-8 in the fall - $170 ($195 late reg.)
High School Camp (July 13-18) - Grades 9-12 in the fall - $190 ($215 late reg.)
Junior Camp (July 20-24) - Grades 3-5 in the fall - $170 ($195 late reg.)
Additional funds for snack bar
To complete registration my sponsoring church will send
Hoodie sweatshirts are available for $35 on an early registration, pre-order only basis
(sweatshirt preview will be on the Pinecroft Facebook page and at www.pobcamp.org)
Hoodie sweatshirt size: Youth: S M L Adult: S M L XL XXL XXXL
Total Amount Enclosed
Please make checks payable to: “Pinecroft”
$ _________
$ _________
$ _________
$ _________
$ _________
$ _________
$ _________
IMPORTANT! Send all registrations and fees to:
ONLY BE PROVIDED FOR PRE-REGISTERED CAMPERS!!
If possible I would like to be in a cabin with:
1._____________________________________
2._____________________________________
(Two choices are permitted, list in order or preference. Requests will be honored as much as possible,
but are not guaranteed.)
Camper Signature: _____________________ Date:________ Parent/Guardian Signature: ________________________ Date:________
Camper’s Name: __________________________________________
Part of the camp experience at Pinecroft Christian Camp is our daily photo and video slideshows. It is from these photos and videos that
we get the images to use for our promotional materials and camp brochures for both Pinecroft Christian Camp and Pend Orielle Bible
Camp (which is our sister facility that we hold Pinecroft Christian Camp at).
[]
I authorize the use of any visual or audio recordings of the person named above for television, radio, magazines, newspaper,
website, brochure, and any other forms of media presentations, for related stories about Pinecroft Christian Camp or Pend
Oreille Bible Camp.
______________________________________________________________
Signature of applicant, or Parent / Guardian if applicant is a minor
___________________
Date
Health & Accident Insurance
first; Pinecroft insurance would cover what your insurance does not. In the event that there is no family insurance, Pinecroft insurance covers
any medical cost resulting from accidental injury sustained while involved in any Pinecroft activities.
Name: ___________________________________________________ Home Phone: ____________________________
Relationship to Camper: _____________________________________ Cell Phone: ______________________________
Does this camper have any special dietary restrictions or requirements? Yes No If yes, please explain: ____________
__________________________________________________________________________________________________