Family Camp 3 Registration Family Camp 3 Registration
Family Camp 3 Registration July 30-August 5, 2017 Family Camp 3 Registration July 30-August 5, 2017
Last Name First Address City Phone ( E-mail Church
Spouse
St )
Zip -
Fees:
Kids Names: Name Name Name Name Name Name Housing Preference #1 #2 Special Needs
M or F (Circle One) M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate
Village Creek Bible Camp 1588 Drake Road Lansing, IA 52151 Or register online at: www.villagecreek.net Questions? Give us a call! 563-535-7320 or [email protected]
Last Name First
# # # #
Adult @ 13-18 @ 6-12 @ 5 & under @
$320 $274 $216 $98
Subtotal
$
Adjusted Fees: ( ) Own Tent/Trailer -$50 ( ) Private bath +$150 (limited availability) ( ) Shared bath with 2 +$75 (limited availability) Subtotal $ Retainer $250.00 Balance Due $
Please return this Registration Form to:
Address City Phone ( E-mail Church
*Families with more than 4 children will pay full price for the 4 oldest children under 18 and receive a 50% discount for all younger children.
Please charge $ to my credit card ( ) Visa ( ) M.C. ( ) Am. Exp. ( ) Disc Exp. Date _____ /______ CIV # (3 digits on back of card) Act # _________-_________-_________-_________ Signature
Spouse
St )
Zip -
*Families with more than 4 children will pay full price for the 4 oldest children under 18 and receive a 50% discount for all younger children.
Fees:
Kids Names: Name Name Name Name Name Name Housing Preference #1 #2 Special Needs
M or F (Circle One) M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate
Please return this Registration Form to:
Village Creek Bible Camp 1588 Drake Road Lansing, IA 52151 Or register online at: www.villagecreek.net Questions? Give us a call! 563-535-7320 or [email protected]
# # # #
Adult @ 13-18 @ 6-12 @ 5 & under @
$320 $274 $216 $98
Subtotal
$
Adjusted Fees: ( ) Own Tent/Trailer -$50 ( ) Private bath +$150 (limited availability) ( ) Shared bath with 2 +$75 (limited availability) Subtotal $ Retainer $250.00 Balance Due $ Please charge $ to my credit card ( ) Visa ( ) M.C. ( ) Am. Exp. ( ) Disc Exp. Date _____ /______ CIV # (3 digits on back of card) Act # _________-_________-_________-_________ Signature
Last Name First Address City Phone ( E-mail Church
Spouse
St )
Zip -
Fees:
Kids Names: Name Name Name Name Name Name Housing Preference #1 #2 Special Needs
M or F (Circle One) M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate
Village Creek Bible Camp 1588 Drake Road Lansing, IA 52151 Or register online at: www.villagecreek.net Questions? Give us a call! 563-535-7320 or [email protected]
Last Name First
# # # #
Adult @ 13-18 @ 6-12 @ 5 & under @
$320 $274 $216 $98
Subtotal
$
Adjusted Fees: ( ) Own Tent/Trailer -$50 ( ) Private bath +$150 (limited availability) ( ) Shared bath with 2 +$75 (limited availability) Subtotal $ Retainer $250.00 Balance Due $
Please return this Registration Form to:
Address City Phone ( E-mail Church
*Families with more than 4 children will pay full price for the 4 oldest children under 18 and receive a 50% discount for all younger children.
Please charge $ to my credit card ( ) Visa ( ) M.C. ( ) Am. Exp. ( ) Disc Exp. Date _____ /______ CIV # (3 digits on back of card) Act # _________-_________-_________-_________ Signature
Spouse
St )
Zip -
*Families with more than 4 children will pay full price for the 4 oldest children under 18 and receive a 50% discount for all younger children.
Fees:
Kids Names: Name Name Name Name Name Name Housing Preference #1 #2 Special Needs
M or F (Circle One) M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate M/F Birthdate
Please return this Registration Form to:
Village Creek Bible Camp 1588 Drake Road Lansing, IA 52151 Or register online at: www.villagecreek.net Questions? Give us a call! 563-535-7320 or [email protected]
# # # #
Adult @ 13-18 @ 6-12 @ 5 & under @
$320 $274 $216 $98
Subtotal
$
Adjusted Fees: ( ) Own Tent/Trailer -$50 ( ) Private bath +$150 (limited availability) ( ) Shared bath with 2 +$75 (limited availability) Subtotal $ Retainer $250.00 Balance Due $ Please charge $ to my credit card ( ) Visa ( ) M.C. ( ) Am. Exp. ( ) Disc Exp. Date _____ /______ CIV # (3 digits on back of card) Act # _________-_________-_________-_________ Signature
