The Springs

Camper's Full Name (last, first, mid): Gender:

Mailing Address:

City: State: Zip Code:

Home Phone:

Emergency Contact: (when parent is not available)
Name: Home Phone:

Cell:

Birth date (mm/dd/yyyy):

Year of Graduation:Grade Next Fall:

Two Buddies I would like to be in a cabin with(Not all requests are guaranteed):

Parent's Name or Legal Guardian:

Work Phone: Cell or Alternate:

Parent's Name or Legal Guardian:

Work Phone: Cell or Alternate:

Church you attend:
City: State:

Camper E-mail:

Your E-mail:
(please double check your email address is correct - you will receive confirmation of your registration via email)

Camper Release:
(list anyone, including parents, that your camper can be released to)

How did you hear about The Springs? Friend Church Web Promotional Event Other

First time camper?  Yes No

Week of Camp:
If you would like to register a camper for both weeks please select the weeks that apply.

A $50 non-refundable, transferable deposit is required with registration:
Deposit preference:
 I will Send a check I will Call with credit card information I will Use Pay Pal (this option is available using the link at the end of this page and includes a $6 charge per registration)

Checks made out to:
The Springs
1950 N M-30
Gladwin, Mi 48624
(include camper name on check)

Phone Number: (989) 426-7604
PayPal Account: thesprings@gmail.com

Please review all information before sending this form.