Wisconsin Christian Youth Camp camper application for 2012

Name__________________________________   boy___ girl___ date of birth  ______/______/______

Parents ___________________________ Grade entering ______ Previous WCYC camper ___yes___no

address__________________________city________________ state____ zip_________

Phone  (      ) _______________  T-shirt size (adult):   S     M     L     XL

Email _____________________________   home congregation (optional) __________________________

I wish to attend the following session: (check one)

Middle - ages 11 - 13

___both weeks; June 17 - 30;  ___first week June 17- 23;   ___second week June 24 - 30.

Intermediate - ages 13 - 15

___both weeks; July 1 - 14;  ___first week July 1 - 7;   ___second week July 8 - 14.

Senior - ages 15 - 18

___both weeks; July 15 - 28;  ___first week July 15 - 21;   ___second week July 22 - 28

Junior - ages 9 - 11

___both weeks; July 29 - Aug 11;  ___first week July 29 -  Aug 4;   second week Aug 5 - 11

Camper : "I agree to abide by the rules and policies of Wisconsin Christian Youth Camp"                       camper signature._____________________  cabin-mate request __________________

The following person has my permission to pick up this applicant at the end of the camp session. Name________________________relationship________

By signing this application I authorize Wisconsin Christian Youth Camp to publish photos of this applicant for camp news and promotion unless indicated with my X below.

____please do NOT publish photos of this applicant.

Parent of Guardian: "I agree that the camp association is released from any liability in connection with the camper named in this application, except as covered by camper insurance carried by this camp."

Parent/guardian signature.  ______________________________

Mail this form along with a $25. deposit to:

WCYC Registrar, LeRoy & JoAnn Latham, 520 Pierce Street, Black River Falls, WI 54615