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First Chance Camp - 2023
July 6th
What do you want to pay today?
Check one:
*
Full Amount ($45.00) [Sold Out]
Church Camper Attends
*
(Choose One)
Altavista Church of Christ
Cool Spring Christian Church
Cornerstone Church of Christ
County Line Christian Church
Forrest Hill Christian Church
Friendly Christian Church
Green Bay Christian Church
Horsepasture Christian Church
Kenbridge Christian Church
Lynchburg Church of Christ
Mayo Christian Church
Mt. Ivy Christian Church
Mt. Pleasant Christian Church
Mountain View Christian Church
Museville Christian Church
North Danville Church of Christ
Oak Grove Christian Church
Oak Ridge Christian Church
Public Fork Christian Church
Rich Acres Christian Church
Salem Church of Christ
Sandy Bottom Christian Church
Sheva Church of Christ
Stella Christian Church
South Danville Church of Christ
Stone Memorial Christian Church
Traditional Christian Church
Whitmell Christian Church
Willow Oak Christian Church
None
Other
Mountain Mission School
Church Discount Code
Apply
Camper Information
Camper Name
*
Date of Birth
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
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Year
2024
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1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Gender
*
Male
Female
Current Age
*
(Choose One)
4yrs
5yrs
6yrs
First time at Camp Pitt
Yes
No
Who will be attending with your Camper? Each Camper MUST have (but no more than) one Parent or Legal Guardian present with them at all times during First Chance Camp.
*
T-Shirt Size - Child
*
(Choose One)
Youth Small
Youth Medium
Youth Large
T-Shirt Size - Adult
*
(Choose One)
Small
Medium
Large
XL
XXL
3XL
Medical Information
Health Insurance Provider (indicate "none" if no insurance)
*
Insurance Policy No. (indicate "none" if no insurance)
*
Group No. (indicate "none" if no insurance)
*
Does the camper have any current or past medical conditions?
*
(Choose One)
Yes
No
Is the camper allergic to or have any adverse reaction to any of the following:
Medication
*
(Choose One)
Yes
No
Food
*
(Choose One)
Yes
No
Plants
*
(Choose One)
Yes
No
Insect bites/Stings
*
(Choose One)
Yes
No
Are any medications being brought to camp?
*
(Choose One)
Yes
No
Is camper RESTRICTED from fully participating in recreational/sports activities?
*
Yes
No
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