Ohio Conference UCC - Division of Outdoor Ministries 
2009 Camp Registration Form

Please complete a separate form for each camper and each camp event.  Complete the registration and email to the Ohio Conference, or print and mail the form.  Submitting this form on line will start the registration process, but you will need to send a copy of the form with the required signatures and payment to complete your registration.

Use the TAB key or click with the mouse to move cursor to the next input box.  Do not use the ENTER key.
Camper's Name 
Street Address 
City     
State  Zip 
Home phone Work phone  (if adult) 
Camper or family email
Please don't give address not checked regularly. We will use this email to contact you about camp if necessary.
Church name City  
Date of birth  Grade (on 4/1/09)   Male   Female 

Camper must be within the grade range specified for the camp they wish to attend.
Please complete the following only if camper is under age 18:                
Father/guardian    Mother/guardian
Work #  Work # 
Email  Email 

Please complete a registration for each camp event desired.
1st choice Event #       Name of event
2nd choice Event #       Name of event
Please charge to:       Visa        Master Card

Please note:  This is not a secure site.  If you would prefer, call us with your credit card information, or include it when you print and send the registration form as requested below.
Credit card #   Expiration date

Charge to this account    Deposit only        Full amount       Other amount   

Authorized signature by   
Please make checks payable to  Ohio Conference UCC.
Signature of parent or guardian
Signature of pastor or Christian education director   
Even though completing this form on line will start the registration process, please print a copy of this form and send it in with the required signatures by parent/guardian and church representative, as well as a legible, official signature, as stated on your credit card, if you are using a credit card for payment.
Camp Fees   (please complete below):
Event fee

Subtract family discount Discount for 3 or more campers from same family.
Subtotal
Subtract enclosed deposit           -  75.00  
Registration will not be processed until deposit is paid.
       BALANCE DUE    
Donation to Campership Fund
Donation to CAMPFIRES Annual Fund
Campership needed:  No   Yes       Application must be enclosed.   Request application.

Please complete this information for your camp's director:
Camper's name    Age    Home phone
If camper is under 18:
Father's /guardian's name  Work phone 
Mother's /guardian's name Work phone 
Please list siblings and their ages:  
Everyone complete the following:
Do you have any dietary needs?    No    Yes    
Do you have any mobility needs?   No    Yes   
Do you have any medical needs?   No    Yes 
Camps you have attended in the past:   
Church activities:   
School activities:  
Hobbies: 
Special request: 
Please add below a few words about yourself that will help the camp staff know you better.
Statement from parent/guardian:  It is our objective and firm commitment to treat each camper as an individual.  Therefore, any information you could share with us concerning your son or daughter would be appreciated and helpful. Include descriptive comments such as:  shy or outgoing, works best alone or with a group, talkative or reflective, etc.  Please do not limit your comments to these categories but, in your own words, help us to provide your child a healthy, growing, Christian camp experience.  Please use a separate sheet of paper and send with the printed copy of this form.
Congratulations!  You are ready to send your camp registration to the Ohio Conference Camp Registrar.  Please review the form for accuracy.  To send it by e-mail to the camp registrar, click the "I am going to camp" button.  Please send your deposit to the Camp Registrar at the address below.
If you cannot send in a registration by e-mail, complete the form and print, or print blank form and complete with typewriter or by printing legibly.  Mail registration and deposit to:
Camp Registrar • Ohio Conference UCC • 6161 Busch Blvd., Suite 95, Columbus OH 43229

E-mail questions and comments to Camp Registrar  or call us at 800-282-0740 or 614-885-0722.