Monitor Sr.

MONITOR - Senior Camp

* Indicates required field

Name *

First

Last

Date of Birth 00/00/00 *

Emergency Contact *

First

Last

Emergecy Contact Phone Number *

Age during camp *

Church Name *

Pastor's Name *

Gender *

Male Female

Have you received the gift of the Holy Ghost? *

Yes No

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Alt. Phone Number *

Name of person paying with PayPal *

First

Last

PayPal email address *

Have you been baptized in Jesus' Name? *

Yes No

Have you been convicted of any crimes involving inappropriate behavior with children? *

Yes, I'll explain. No

If yes, please explain. *

Please list any medical conditions we should be aware of: *

List any medications that may be taken during camp: *

Upload a photo of yourself (optional) *

Max file size: 20MB

Select T-shirt Size *

Please also print & fill out a registration form by visiting the printable files link.
This form must be signed by your pastor.

I agree to abide by all rules and guidelines that be found on acofla.com *

Yes

Submit