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Adult Campers Names or N/A^*

Attending Parent / Guardian responsible for campers under 12. or N/A^*

The Camp you'd like to attend^*

Week 1: July 10-16Week 2: July 17-23Adult Weekend:N/A for 2022Young Adult:N/A for 2022

Adult Accomodations^*

I need a cabin for 1-2 peopleI need a cabin for 3-5 peopleI am providing my ownN/A

Under 18 Campers Names or N/A^*

Under 18 Campers sex and grade or N/A^*

Emergency Contact: Name^*

Emergency Phone #^*

Medical Conditions/Dietary Needs of Campers/Adults. Students who require a personal aid at school must be accompanied by a full time aid at camp.

After pressing SUBMIT, the Healthcare/Consent form will down load. Only press SUBMIT if you are confident you want to register for and attend this camp. You will receive a confirmation email.

fill out the following form

Contact Information:

Funding

Pembina Bible Camp Fellowship

mailed to:

Pembina Bible Camp 2022