Hickory Hollow Registration « Camp Bethel Ministries « Wise VA

Please fill out this form for Hickory Hollow Day Camper Registration.

Once you have successfully completed and submitted this form you should print out the Payment Form to send in with your payment (this will require Adobe Reader).

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Camper Information
Camper Last Name(required)
Camper First Name(required)
Address(required)
City(required)
State
Zip(required)
Gender
Date of Birth(required)
Age as of May 1, 2009
Grade completed by June 2009
Camper's Email
Cabin Buddy?
Parental or Guardian Information...
Parent's Names(required)
Parent's Address(required)
Home Phone(required)
Other Phone
Parent's Email(valid email required)
Other Adult Name(required)
Relationship
Church you attend
Assoc. Church Name (if coming with church)
Check any and all that apply...
Day Camp 1 @ Hickory Hollow - June 8-12
Day Camp 2 @ Hickory Hollow - June 15-19
Day Camp 3 @ Hickory Hollow - June 29 thru July 3
CommentsComments, Questions, or Suggestions
Registration is not guaranteed until payment is received...
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