Camp Connections » Family Camp Registration

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First Name *

Surname *

Date of Birth (YYYY/MM/DD) *

Age

Street Address *

City/Town *

Province/State *

Postal Code / ZIP *

Billing Email Address

Phone Number *

Health Card Number *

Church Affiliation *

Emergency Contact 1 Full Name *

Emergency Contact 1 Home Phone *

Emergency Contact 1 Cell Phone *

Emergency Contact 1 E-Mail *

Emergency Contact 2 Full Name *

Emergency Contact 2 Home Phone *

Emergency Contact 2 Cell Phone *

Emergency Contact 2 E-Mail *