4-6th Super C Registration | Midland Ministries

Super C Registration
June 23-26

*4th-6th Grade*

Registration Cost:

$50 nonrefundable deposit

$155 Early Registration

After May 31st- $185

Camper Infomation

Download Printable Registration

Camper's First Name

Camper's Last Name

Male

Female

Age

Grade this Fall

Street Address

City

State

Zip code

Want to Room with...

Church

Parent/Guardian Name(s)

Phone

2nd Parent/Guardian Phone

Please make sure the parent phone/email are correct as this is how we will contact you before/during camp.

Emergency Contact (non-parent)

Emergency Contact Phone

Relationship to Camper

Please list Camper's Allergies, Medications, or Medical Conditions we need to be aware of below:

All medications will be collected at registration and kept in the camp medical room.

I give my Camper permission to participate in the following extra activities:

Blob

Water Slide

Archery

BB Guns

By checking this box and typing my name, I acknowledge this as my electronic signature of consent to activities and permission for camp staff to treat medical issues if they arise for my camper. Midland Ministries is not liable for sickness, injury, or theft of property/money during their time at camp.

To complete your registration for Super C 4-6th Week, follow this link to our giving page to pay your camper's $50 deposit or their full balance of $155.

(Remaining $105 is due at Super C Registration)

Payment should be made on the "Quiz Camp & Super C Registration" line of the giving page.

Thank you!

Download Information about Super C and what to bring here.

Super C Registration
June 23-26

CONTACT

You can also contact us by using this form:

JOIN THE MAILING LIST

Super C Registration June 23-26

CONTACT

You can also contact us by using this form:

JOIN THE MAILING LIST

Super C Registration
June 23-26