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Shiloh Chapel Youth Ministries Online Registration Form at Shiloh Chapel

Snow Camp 2005

Snow Camp · Grades 6-12 · Friday Feb. 18th at 5:30 pm until Sunday February 120th at noon

Registration Deadline: February 11th.  $35.00 per person, $20.00 for each additional Child.

Fill out online registration for each child before February 11th.  Remember to bring the camp donations for each child and a signed medical release form for each child. 

Last Name:     First Name:    Grade in Fall: 6 7 8 9 10 11 12 Grad     DOB:

Street:    City:    State:    Zip:

Home Phone Number:           Alternate Phone#:

 Gender (choose One): Male     Female      

Parent(s) Names:   Email (required):

Emergency Contact Phone Number:      Name:     Relationship:

I have read the Camp Rules with my child:    Date:

Health History

Health History (as it applies to Weekend Camps), Please check/explain any that apply:

          Date of Last Tetanus Shot  

     Does your child have any special needs we should anticipate? (special diet, diabetes, asthma, allergies, behavioral challenges.  Please describe including medications taken.

 Please explain completely.

     Do we have permission to give "Tylenol" type medication for minor medical Needs: Yes No

    Please print out, sign, and bring the Medical Emergency and Liability Waiver for each camper.  Your child cannot attend the Winter Snow camp without this form.