Rebel MS Camp Registration

who: Anyone in grades 6-8 during the 07-08 school year

what: Middle School Camp is an event designed to encourage students to pursue the life that God desires for them.

where: Camp Como - Como, CO (www.campcomo.com)

when: June 22-27. We will be leaving Southeast at 2:00pm on the 22th, and return at 12:00pm on the 27th.

cost: to reserve the following rates, a $50 deposit is due on the dates listed below:
Early-bird rate: $200 (by May 11)
Regular rate: $230 (by June 8)
Last minute rate: $260
Several fundraising opportunities will be made available to help with the cost of the trip.

what to bring:
sleeping bag
pillow, toiletries
clothes for 5 days (plus clothes for free rec and sports activities, warm clothes for evening, and clothes that can get messy)
shoes suitable for hiking
backpack
sunscreen
water bottle
Bible and pen
spending money for snacks & bookstore (optional)
*Please no mp3 players.

IMPORTANT: Please bring the following two forms, filled out, with you to give to Southeast staff before the trip departs. Your parent or guardian must fill these out for you to be able to participate in the trip. Camp Medical Form. SSM Medical Form.

questions? contact Jerran Wolf at 720-842-5508 or jerran.wolf@sechristian.org

NOTE: This registration is for the Early-Bird full registration amount of $200. If you would like, instead, to make a $50 non-refundable deposit at this time to reserve a spot, please click here.

Registration:

General Information

Student's Name*

Grade during 07/08 school year

Check One*
Male
Female

Address*

City*

State*

Zip*

Home Phone Number

Cell or Daytime Phone

Parent(s) Name*

Emergency Contact Name*

Emergency Contact Phone Number*

Parent Email Address*

Medical and Liability Release

We realize that no activity is without the possibility of unforseen hazards which could result in injury to an individual. As a parent or guardian, you are to be aware of your responsibility to instruct your child of the importance of conduct which will insure safety and enjoyable time while participating in this activity. By clicking below, you, as a parent, guardian or other responsible party, agree to assume the risks and hazards which are inherent in this kind of activity. You also agree to absolve and hold harmless the sponsoring organizations and their representatives for damage, loss, or injuries to the child for whom you sign.

I further give my permission for the use of any photo or likeness of my child to be used by the sponsoring organizations for their use in promotional materials.

I give my child permission to participate in this activity, and give my permission to the leaders of this function to authorize any treatment deemed necessary by a licensed physician due to accident or illness during this activity.*

I AgreeI Do Not Agree

Full Parent/Guardian Name*

Date*

Other

Comments

Payment

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