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Minnesota Conference UCC

 

The United Church of Christ

 

Outdoor Ministries Association UCC

 

 

Pilgrim Point Camp

A Ministry of the Minnesota Conference

of the

United Church of Christ

 

 

HEY!! I told you not to click!!!!

This is an experimental Registration form. Do NOT use it to register for camps at Pilgrim Point Camp

 

I mean it this time!!

(unless, of course, I asked you to help test the system)

 

         

            * Required Field

        Name of camp and dates *                

      

    Camper Information

        Camper's last name *                       

        Camper's first name *                       

        Camper's email                               

        Camper's gender *                           

        Camper's birth date mm/dd/yyyy       

        Grade Completed in 2010 *               

        Street address or PO Box *               

        City *                                            

        State *                                          

        Zip Code *                                     

 

    Parent/Guardian Information

        a -Parent or Guardian 1 *                

        a -Phone 1 *                                    *

        a -Phone 2  (Work or cell)                   

        a -email                                       

        b -Parent or Guardian 2                  

        b -Phone 1 (home or cell)                   

        b -Phone 2 (Work or cell)                   

        b - email                                     

 

    Emergency Contact Information

        Emergency contact name               

        Emergency contact phone                

       

 

        Person(s) authorized to pick up camper *   

 

        Name of your local church             

        City of local church                      

 

        Special needs                             

       

 

 

Registration Form