MALAGA CAMP REGISTRATION FORM - ONE REGISTRATION FOR EACH WEEK

Enclose a non-refundable deposit of $75.00 for each week (Day Camp Deposit is $50.00). The total amount for all camp(s) is based on when we receive your
FINAL PAYMENT. Balances for all camps being attended must be received (not postmarked) by the 2nd Friday of July.
CAMP SELECTION - PLEASE CHECK THE CAMP(S) YOU PLAN TO ATTEND:
Grades 1, 2 or 3

______

#100 Day Camp

MUSIC & DRAMA CAMPS:

Grades 4, 5 or 6

______

#101 Junior Camp

Grades 5 - 8

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#102 Junior MAD

Grades 7, 8 or 9

______

#201 Middler Camp

Grades 9 - 12

______

#202 Senior MAD

Grades 7 - June Grads

______

#301 Sports Camp

Ages 18 23 years

______

#502 MAD Gold

Grades 7 - June Grads

______

#301 We 3 Camp

Grades 10 - June Grads

______

#401 Senior Camp

ALL MAD CAMPS ARE THE SAME WEEK

PRINT AND FILL IN COMPLETELY

Camper's Name ______________________________________________________________

T-SHIRT SIZE

Male ________ Female ________ Grade in September _____________________________

The T-shirt cost is included in the camp cost.

Birth Date (mm/dd/yyyy) _____________________________________________________

Please choose carefully as we cannot re-order.

Childrens Sizes

Parent's Name ______________________________________________________________

Adult Sizes

Mailing Address ______________________________________________________________

______ Small (6 8)

______ Small

City ____________________________________ St ________ Zip Code ________________

______ Medium (10 12)

______ Medium

Contact Phone # (Include area code) ____________________________________________

______ Large (14 16)

______ Large

Parent's E-mail Address:_______________________________________________________

______ X Large

Are You a Returning Camper? YES _________ Or Your First Time At Malaga? ___________

______ XX Large

Room with: _________________________________________________________________

(Room placement is at the discretion of the camp's director)

CHURCH INFORMATION
Full Name of Church

______________________________________________________________________________________________________________

Church MAILING Address

______________________________________________________________________________________________________________

City

___________________________________________________________________ St _______ Zip______________________________

Lead Pastor's Name Rev.

______________________________________________________________________________________________________________

Contact Phone # Include Area Code ____________________________________ E-Mail Address __________________________________________________________

FINANCIAL ASSISTANCE REQUEST
Adult(s) Requesting Financial Assistance: (Not The Campers Name]

Brief Explanation as to why you need financial assistance:

___________________________________________________________________

____________________________________________________________________

___________________________________________________________________

____________________________________________________________________

TWO REQUIRED REFERENCES WHO ARE AWARE OF YOUR FINANCIAL NEED

1) Pastors Name ____________________________________________________

2) Full Name _________________________________________________________

Phone # - Include Area Code __________________________________________

Relationship to Camper ________________________________________________

E-Mail _____________________________________________________________

Phone # - Include Area Code ____________________________________________

E-Mail _______________________________________________________________

FOR CAMP USE ONLY

Date Paid

____________________

Amount Paid

__________________

Check # _________________

Date Paid

____________________

Amount Paid

__________________

Check # _________________

Date Paid

____________________

Amount Paid

__________________

Check # _________________

FOR CAMP INFORMATION

Questions regarding registration only: .............. 856.692.6517 Ask For, Or Leave A Message For Debbie Witte

Mailing address:........................................ Malaga Camp Registrar, 4488 Arbutus Avenue, Newfield, NJ 08344-2127

Make Checks Payable To: ............................. West Jersey Grove Association

E Mail: ................................................... youthregistrar@malagacamp.org

Youth_Registration_Form_2012