Universal Church for Christian Youth, Inc.

Empowering Christian Student Athletes Thru Faith, Academics and Sports

Camper Name: __________________ Camp STORM Participation Registration Form               Age: _____

Camper:

First ___________________________________________ Middle _________________ Last ____________________________     _______

 

School Name ______________________________________________________ Grade _______Birth date _________/_____/___________

 

Street Address_____________________________________________________________________________________________________

 

Town/City ____________________________________________________________________ State ______ Zip code _________________ 

Parent/Guardian - Contact Information

First____________________________________________Last______________________________________________________________

 

Street Address_____________________________________________________________________________________________________

 

Town/City ______________________________________________________________________ State __________Zip Code ____________

 

Home Phone _____________________________Work Phone ____________________________Cell ________________________________


E-mail ____________________________________________________E-mail___________________________________________________

 

Emergency Contact Information

Emergency Contact #1

First Name ___________________ Last Name ___________________ Home Phone ________________ Work Phone _________________

 

Cell Phone ____________________ Email ______________________________________ Relation to child __________________________

 

Emergency Contact #2

First Name ___________________ Last Name ___________________ Home Phone ________________ Work Phone ________________

 

Cell Phone ___________________ Email ________________________________________ Relation to child ________________________

                            

Camp STORM Fee Information:

 

Football Camp - $ 600.00 (Sunday – Friday) $ 300.00 due with registration, $300.00 due 2 weeks prior to camp.

 

Weekend Warriors- $ 225.00 (Friday – Sunday) $ 100.00 due with registration, $ 125.00 due weeks prior to session.

                                 (see Spring/Fall calendars for Weekend Warriors scheduled weekends)

 

Please CIRCLE CAMP sessions for attendance----

 

       Sunday, June 9 – 14, 2019                     Sunday, June 16 – 21, 2019                         Sunday, June 23 – 28, 2019

 

 

       Sunday, July 7 – 12, 2019                      Sunday, July 14 – 19, 2019                           Sunday, July 21 – 26, 2019

 

Checks are made payable to--- Universal Church for Christian Youth, Inc.


Mail to – Coach Wes Johnson, 4050 Gamble Mill Road, Avera, GA 30803   or    E-mail to – [email protected]