Fall Fan the Flame 2010

 REGISTRATION FORM

THERE ARE TWO FORMS! All fields on these forms are required .
Please fill out the forms completely then Print the forms - Sign the forms
Mail the printed forms, with payment, to :
Dwen Bontrager    6361 Myers Rd NE  Kalkaska, Mi.  49646   231 384-1189

Camper Information Section
Camper Full Name:   Grade   B-Day
Street Address:
P.O. Box:
City:
State:
Zip:
Email Address: MSN Contact Info
Parent / Guardian Information Section
Parents Name:
Street Address:
P.O. Box:
City:
State:
Zip:
Home Ph: Cell:
Work Ph:
Emergency:

I, the undersigned parent/guardian of the child(ren) named above, have read and agree to the guidelines and give permission for my child to attend Fall Fan the Flame, Nov. 5-7,2010. DO NOT FORGET TO FILL OUT THE MEDICAL RELEASE FORM HERE

Parents Signature:______________________________________ Date:___________