For a printable registration form, please Click Here.

Camper's Name:
Age and Grade in 08-09 School Year:
Birthday:
Male      Female
Parent/Guardian Name:
Mailing Address:
City, State and Zip:
Phone:
Email Address:
Church You Attend (Please include city):
In Case of Emergency Notify:
Emergency Contact Phone Number:
Insurance Carrier/Company:
Policy #:

Please list who your camper can leave with or give permission for your teenager to drive home. No child will be able to leave with a person that is not listed. The person who picks each camper up must present photo identification in order to sign them out.

Please mark the event you are registering for:
Training Camp (May 27-30, Free Will Donation)

Wilderness Camps ($95-Pre-registration / $110-Less than 2 weeks in advance)
1st Week (June 9-13)   2nd Week (June 16-20)   3rd Week (June 23-27)

Junior Camps ($85-Pre-registration / $100-Less than 2 weeks in advance)
Junior Girls Camp (June 23-27)     Junior Boys Camp (July 7-11)

Intermediate Camps ($85-Pre-registration / $100-Less than 2 weeks in advance)
1st Week (July 14-18) 2nd Week (July 21-25)

Senior Camp ($100-Pre-registration / $120-Less than 2 weeks in advance)
1st Senior Camp (June 1-6) 2nd Senior Camp (July 27-August 1)

Back 2 School Bash (August 22-23, $40)

Family Style Canoe Camp (September 26-28, $70)

Winter Camp/Youth Conference (December 29-January 1, $40)

I would like to purchase a Camp Rock "Shine" t-shirt. The cost is $15.
Please select a shirt size:

List any medications your child needs. All medication is kept in a locked cupboard and will be dispensed by Camp Rock personnel.

Camp Rock is open to all regardless of race, color or national origin.

I hereby give permission for my child to receive treatment in the event of an emergency. I hereby grant permission for Camp Rock personnel to supervise the prescribed medication for my child and to dispense non-prescription medication when deemed necessary for the well being of my child. I will not hold American Missionary Fellowship or its Missionaries or Camp Rock Inc. responsible in case of accident or sickness. I understand that each camper is covered by a limited insurance. I give permission for pictures of my child to be used in any Camp Rock publication.

Parent check here to confirm that you have read and agree with policy stated above.
Camper check here to confirm that you will obey the Camp rules and conduct yourself as instructed.
  
You will receive confirmation of your registration when your registration and payment are received.

 
Please email info@camprock.net with any questions or comments.
This site last updated January 2, 2008.