Pilgrim Point Camp Registration

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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