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GODS COUNTRY

MINI-CAMP
REGISTRATION
FORM
Parent 1
Last
name____________________________
First
name____________________________
Home
phone____________________________
Work
phone____________________________
Cell
phone____________________________
Email_____________________________
Parent 2
Last
name____________________________
First
name____________________________
Home
phone____________________________
Work
phone____________________________
Email_____________________________

Address
Street____________________________
City_____________________________
State/Zip_________________________
Camper Info
Last
Name_________________________
First
name_________________________
Birthday______________________
Grade in school (upcoming)_______
E-mail_________________________
Registration fee $________________
Make checks to: Pleasant View UM
Church
Mail payment and registration form to:
Pleasant View Church
P.O. Box 7
Kellogg, IA 50135
Mark envelope: Mini-camp
Scholarships available. Call
641-417-9463 to request application
Space limited. Registration deadline:
July 24

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