Middle School Week - 2022

July 17th-22nd

What do you want to pay today?

Check one:*

Full Amount ($230.00)
CP Scholarship (pre-authorization required) ($230.00)

Remaining Balance will be charged to the credit card used on this registration form on July 3, 2022 unless your church will be paying the remaining registration fees. No money will be collected at check-in.

Camper Information

Camper Name*

Date of Birth*

Gender*

Male
Female

Current Grade (2022)*

Tshirt Size*

Camper is an immersed believer

Church Camper Attends*

First time at Camp Pitt

Who can pick up camper? Camper will ONLY be released to a person on this list*

Is anyone restricted from picking up or having contact with camper?*

Do you have a friend you would like to be in the same dorm with? Please name one friend below. This friend will need to register within 7 days of your registration and also name you as their friend in order to be placed in the same dorm.

Name one friend

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?*

Is the camper allergic to or have any adverse reaction to any of the following:

Medication*

Food*

Plants*

Insect bites/Stings*

Are any medications being brought to camp?*

Is camper RESTRICTED from fully participating in recreational/sports activities?*

Is camper permitted to swim in 5 ft. end of pool?*

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