Red fields are required.
1. Camper's Name: First: Last:
Phone: (enter 10 numbers, include area code)
Camper's E-Mail address:
Date of Birth: Select January February March April May June July August September October November December ?? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ?? 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Other If year is "Other", fill in other year:
Sex: .Male .Female
Grade in School as of September, 2006 : .9 .10 .7 .11 .8 .12
2. Parent or Guardian Name: Address: City: State: ?? NJ NY PA Other Zip Code: (enter 5 or 9 digits) If state is "Other", list state (2 letters) Day Phone: (enter 10 numbers, include area code) Evening Phone: (enter 10 numbers, include area code) Parent's E-Mail address:
3. Dates and Program Attending:
Program: .Snow Camp
Dates: .Arriving: February 23, 2007 .Departing: February 25, 2007
4. Group Information:
Group Name and address: .Our Hope Ministries .40 Fox Hill Lane .Hillsborough, NJ 08844-5212 .(908) 359-2574
Group Leader's Names: .Thomas and Cathy Bell
5. Have you ever attended a Word of Life Camp before?:
.Yes .No
If YES, when was the most recent time you attended?: Select Island 2006 Ranch 2006 Snow Camp 2006 Island 2005 Ranch 2005 Snow Camp 2005 Island 2004 Ranch 2004 Snow Camp 2004 Island 2003 Ranch 2003 Snow Camp 2003 Island 2002 Ranch 2002 Snow Camp 2002 Island 2001 Ranch 2001 Snow Camp 2001 Island 2000 Ranch 2000 Snow Camp 2000 Island 1999 Ranch 1999 Snow Camp 1999 Other If other, when was the most recent time you attended?
6. Do you have any physical limitations: .Yes .No
If YES, please describe: .
7. What church do you attend?: (if none, type None) City: (if none, type None)
8. Do you want someone to call you about scholarship needs? .Yes .No
We will NOT let cost be a reason for not going. If cost or deposit is a problem, PLEASE call us about scholarships. There is a LIMITED scholarship fund available. Any scholarship needs MUST be arranged when returning this reservation.
Reservations must be made immediately. Space is limited !! ---------------- Total cost is $149.00. Please see #8 above if cost or deposit is a problem. ----------------- Reservations must include a $75.00 deposit. (Deposits are transferable but not refundable.) Make checks payable to, and mail within 2 days to Our Hope Ministries (see #4 above). Reservations are not confirmed until deposit is received or other arrangements are made! ---------------- We appreciate additional donations which help us to help others to go to these events ! ---------------- For further information, or to pay by credit card, call Our Hope Ministries at (908) 359-2574.
CAUTION: AFTER PRESSING “SUBMIT”, IF YOU DO NOT GET A CONFIRMATION THAT
YOUR FORM WAS SENT, PLEASE CALL OURHOPE MINISTRIES AT 908-359-2574
TO VERIFY YOU’RE YOUR REGISTRATION WAS RECEIVED.