Camp Form

Join Impact PCG for camp this July!
Teen 13-19 July 7th- 11th (Cost $205 per student)
Kids (5-12) July 21-24th (Cost $155 per student)

1Camper Information > 2Untitled Page > 3Emergency Contact and Medical
What Camp will your student be attending?

What Camp will your student be attending? Teen Camp (6th - 12th Grade) Kids Camp (k - 5th Grade )
Name Name First Last
Campers Date of Birth Campers Date of Birth / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone Phone - ### - ### ####
Name of Church you attend
Are you permitted by legal guardian to swim at camp?

Are you permitted by legal guardian to swim at camp? Yes No
List any activities my camper will not be allowed to participate in.
Camp Policies
By Checking this box I and my Camper agree to and will abide by the Camp Policies Stated above.

By Checking this box I and my Camper agree to and will abide by the Camp Policies Stated above. I agree