Camp Cotubic - Bellefontaine, Ohio

Summer Camps >> Event Registration

Camp participants can now register online using the form below. Once submitted, you will be forwarded to a page where you can choose to also pay online.

A $100 non-refundable deposit is due by April 30th, 2013. Late registrations are accepted, however space is limited and spots are reserved on a first deposit-paid basis.

Don't want to register online...Click here for our printer friendly registration form.
Please print our Medical/Emergency Form and bring the completed form with your son or daughter when camp begins.

PERSONAL INFORMATION

Female

Male

Grade Finished June 2013:

Last Name:

First Name:

Mother's Name:

Father's Name:

Mailing Address:

City:

State:

Zip:

Phone:

*Parent's E-Mail:

*Parent's E-Mail address is required and used for confirmation letter only

*Camper's E-Mail:

*Camper's E-Mail address is required and used for confirmation letter only

Church Name:

Cabin Mate:

EVENT ATTENDING (Grades Completed in June 2013)

Teen Challenge Camp (7th-12th grades completed) June 9-14, 2013

Discovery Camp (5th – 6th grades completed) June 23-28, 2013

Voyager Camp (2nd-4th grades completed) July 14-18, 2013

Teen Fall Retreat (7th-12 grades completed)

Winter Fund Raising Rally (Jan 19, 2013)

PLEASE NOTE:

Camp cost include: Camp T-Shirt, Activities, All Meals and Lodging for the Week. However, when calculating complete payment please consider the following:

Sibling Discount: For families with more than one child attending camp, please deduct $25.00 for every child after the first child's full registration. Pay full amount for the oldest child and take discount for the younger campers.
The amount of your Church to Pay (If Known)
If you have any questions, feel free to call the camp at 937-468-2519.
A $100 non-refundable fee is due by April 30th, 2013.

Questions or Concerns Please Describe Below

By using the reCAPTCHA tool to the left,
you are helping prevent spam.