2019 Summer Youth Camp Registrations

2019 Youth Camp Registration
Week Attending

Pioneer Camp (June 26-28) Jr. Adv. Camp (July 1-6) Jr. Outdoor Adventure Camp (July 15-20) Outdoor Adventure Camp (July 15-20) Leadership Camp (July 22-27) Jr. High Camp (July 29-Aug 3) Teen Camp (Aug 5-10)
Camper Information
Camper Name *

First Name Last Name
Gender *

Male Female
T-Shirt Size *

Youth S Youth M Youth L Small Medium Large X-Large
Age *
Grade Entering

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
E-mail *
First Time Camper?

Yes No
Cabin Pal?
Church Name
Church Phone

- Area Code Phone Number
Health Information and Parental Permission
Father's Name

First Name Last Name
Mother's Name

First Name Last Name
Home Phone Number

- Area Code Phone Number
Work Phone Number

- Area Code Phone Number
Cell Phone Number

- Area Code Phone Number
Emergency Contact (not parent) *

First Name Last Name
Emergency Contact Number *

- Area Code Phone Number
Your Insurance Company
Insurance Policy No.
Any additional questions, allergies, or other important info:
Health Forms - Laws require a physical within 24 months preceding your camp week. Updated shot records are also required. A photocopy of a school physical is acceptable. Forms are also available online at www.campnorthfield.com/wordpress/camp-forms or by request. A registered nurse or EMT is provided for proper care of campers in case of illness or accident.
If emergency treatment is deemed necessary, I give consent for such treatment of my child (named above) by authorized personnel. I certify my child has permission to attend camp.
E-Signature

First Name Last Name
A deposit is required with this form. You may choose to make your deposit here or pay the whole balance. You may also opt to mail in your payment to:

Camp Northfield

96 Wanamaker Rd

Northfield, MA 01360

(Note: if you are going to be mailing in your payment, you do not need to use the checkout below. Please mark "No charge: I will mail in my payment/deposit" and skip to the submit button. Thank you for choosing to use our online registration!
Payment Options

I will mail in my payment/deposit Pay deposit or in full by credit card now
Discounts

To enter a discount, use one the following codes in the coupon code box

"MultipleWeek01" - for a $10.00 discount if you are registering for more than one week.

"EarlyBird02" - for a $15.00 discount for registering by May 1st

"Ministry03" - for a $20.00 discount if parents are pastors, missionaries, SS teachers, or Christian School teachers.

Online Registration Wizard

Deposit Only $ 90.00

Pioneer Camp $ 155.00

Jr. Adventure Camp $ 285.00

Jr. Outdoor Adventure Camp 2 $ 285.00

Outdoor Adventure Camp $ 285.00

Leadership Camp $ 285.00

Jr. High Camp $ 285.00

Teen Camp $ 285.00

Paintball (Ages 13+) $ 20.00

Bivouac Bucks (Bookstore Card) $ 10.00

Quantity

Enter coupon

Total $ 0.00

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2019 Youth Camp Registration

Camper Information

Health Information and Parental Permission

Discounts