You can register by mail by completing this registration form, printing it, and sending it along with your payment to Camp Witness, HCR 62 Box 30B, Long Pine NE 69217

This is the Print and mail form:

It will NOT be submitted online!

Registration form

Camper's First Name Middle Initial Last Name

Father's First Name Father's Last Name

Mother's First Name Mother's Last Name

Address Address 2

City State Zip

Home Phone Emerg. Phone

Email Grade Age

Male Female

Birthdate

Camp you wish to attend

Health problems we should know about

Allergies

Have you attended Camp Witness before? Yes No

How did you hear about Camp Witness?

Name of Home Church

Church's Location: City State

Pastor's Name

I will go home with my parents at check-out time. Yes No

I will go home with this person at check-out time.

Additional Comments

Total Payment Enclosed

Please print completed form, be sure to sign the medical release statement below after printing. Thanks.

Medical Release: “In case of sickness or accident, Camp Witness has my authorization to obtain such medical attention as is deemed necessary for my child, if unable to communicate with me immediately.”

_____________________________________

Parent’s Signature