Youth Registration | Grandparent/Kid Camp | Online Payment | Scholarship Form <div id="CamperDelete-{0}" class="bottommargin-sm"> <div class="row align-self-end"> <div class="col-4"> <label for="inputLname">Additional Camper Name</label> <input type="text" class="form-control" id="intputCampers-{0}" name="intputCampers[]" required> </div> <div class="col-3"> <label for="inputGender">Gender</label> <input type="text" class="form-control" id="inputGender-{0}" name="inputGender[]" required> </div> <div class="col-4"><fieldset id="BirthFields-{0}"> <label for="register-form-birthmonth">Birthdate </label> <div class="row"> <div class="col-4"> <select name="register-form-birthmonth[]" class="form-control calcage" id="register-form-birthmonth-{0}" > <option value="">Month</option> <option value="1">January</option> <option value="2">February</option> <option value="3">March</option> <option value="4">April</option> <option value="5">May</option> <option value="6">June</option> <option value="7">July</option> <option value="8">August</option> <option value="9">September</option> <option value="10">October</option> <option value="11">November</option> <option value="12">December</option> </select> </div> <div class="col-4"> <input type="text" id="register-form-birthday-{0}" placeholder="Day" name="register-form-birthday[]" value="" class="form-control calcage" /> </div> <div class="col-4"> <input type="text" id="register-form-birthyear-{0}" placeholder="Year" name="register-form-birthyear[]" value="" class="form-control calcage" /> </div> <input id="birthdayfull-{0}" name="birthdayfull[]" type="hidden" class="CheckThis" autocomplete="off" readonly required> <input id="calcage-{0}" name="calcage[]" type="hidden" autocomplete="off" readonly /> </div> </fieldset></div> <div class="col-1 d-flex align-items-center"> <a href="#" class="DeleteDiv hide-{0}" id="DeleteDiv-{0}"><i class="fa fa-trash" aria-hidden="true"></i><br> Remove</a> </div> </div> </div> STEP 1: CAMPER GROUP INFORMATION Last Name of Adult #1 First Name of Adult #1 Address City State Zip Best Phone Email STEP 2: Please List all persons attending in your family/group. Include last name if different from adult 1): 1st Adult Gender Birthdate MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Add Additional Camper STEP 3: Are you registering for : Grandparent/Kids July 5-8 Housing Desired: Agape Cabin (4 available) We’re Flexible and willing to share a cabin. (Provide name of other family, if you have agreed with them.) Will bring a Camper/RV/Tent trailer STEP 4: PAYMENT INFORMATION & REFUND POLICY A $50 deposit is required to complete this regitration online. Registration deposits are non-refundable. Full payment is due by June 10. After June 1, additional fees paid will only be refunded for emergency or medical reasons. STEP 5: FEE CALCULATORThe fees charged for our programs do not cover the full cost of the week at camp. In addition, many of our campers would not be able to attend at all without additional financial support from our Campership fund. If you are financially able, your support of our Campership Fund would be greatly appreciated. I/We would like to make an additional donation to the Agape Campership Fund $ Association Members Discount - $25 if your congregation is a member of the Agape Ministry Association. Name and City of your congregation: CongregationBethany LC, Dormont (ELCA)Brighton Heights LC, Pgh. (NALC)Emmanuel LC of Eastmont, (Penn Hills) Pgh (ELCA)Faith LC, Laurel Gardens, Pgh. (ELCA)Faith LC, Upper St. Clair (ELCA)Grace LC, Steubenville, OH (ELCA)Grace LC, Troy Hill (NALC)Resurrection LC, Oakdale (ELCA)St. John LC, Carnegie (ELCA)St. Mark LC, Butler (NALC)St. Paul’s LC, Canonsburg (ELCA)St. Paul LC, Washington (ELCA)St. John LC, Connoquenessing (ELCA)Stewart Ave. LC, Pgh. (ELCA)Trinity LC, Gibsonia (ELCA)Zion LC, Brentwood, Pgh. (NALC) Amount Paying Today $ Total Amount Due $ If you have a payment code, enter it here STEP 5: HEALTH FORMS AND PARENTAL CONSENT Agape Ministry MUST have health forms for all campers, regardless of age. These do not require a doctor’s signature or any physical examination. However, for children they must be signed by a parent or legal guardian. The forms also include a Parental/Legal Guardian consent for their child(ren) attending camp to participate in the camp activities. These forms will be available online at our website, www.campagape.org or by mail if you request them. Legal Relationship to the Group Registered Loading...
