CAMPER APPLICATION

Please fill out this form for each Camper. Once you submit the form, reload the page in your browser to reset the form if needed for another camper.

Phone

This field is for validation purposes and should be left unchanged.

Ages 8-21

CAMP COST is $90.00 A deposit of $45 is due with this application. The remaining $45.00 will be due upon arrival at camp. There is also an ooption to pay the whole $90. A late fee of $10.00 will be added to applications received after July 1st.

Camper's Name(Required)

(please circle) Male or Female(Required)

Male

Female

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Age(Required)

Home Church(Required)

Pastor's Name(Required)

Pastor's Phone(Required)

Counselor Requested:

Roommate Requested:

Emergency Contact Information:

Emergency Contact Name(Required)

Relationship to Camper(Required)

Emergeny Contact Phone #(Required)

Camper must read and sign below: I promise to obey and honor my counselors and all camp staff. I promise to obey all camp rules and always keep myself modest. I promise to come with an open heart and a hungry soul.

Camper's Signature - I have read the Rules, Dress Code and Responsibilites and will abide by these(Required)

Date Signed(Required)

Parent or legal guardian must read and sign below: For medical purposes a parent must sign this. I agree to allow the directors of Tiger Mountain Holiness Youth Camp to seek medical attention for my child in the event of an emergency or accident and hereby waive my rights to hold Tiger Mountain Holiness Youth Camp and/or its directors liable for any accidents.

Parent's Signature(Required)

Date Signed(Required)

(Optional) Parent Signature for swimming:

(If not signed, camper will not be allowed to swim.)

NOTE: Your Pastor must complete the Pastor's Evaluation

Payment Method

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