2022 CAMPER REGISTRATION FORM
First Name
*
Last Name
*
Middle Initial
*
Date of Birth
*
YYYY
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Gender
*
Male
Female
Address
*
Name of School
*
Parent/Guardian’s Contact Information: 1
Name
*
Relation
*
Address
*
Organization/Workplace
*
Email
*
Mobile
*
Home
Work
Parent/Guardian’s Contact Information: 2
Name
*
Relation
*
Mobile
*
Home
Work
Medical Information:
Doctor's Name
*
Organization/Workplace
Allergies
Mobile
*
Work
Travel History:
List the local parishes the camper has visited in the last 21 days ...
List the countries the camper has visited in the last 21 days...
Has the camper / contacts of the the camper in the last 45 days , been screened / tested for COVID19 ?
YES
NO
Optional Activities - Sports:
*
Choose one option from the following:
Select...
Option 1: Football,Swimming,Golf,Dance,Art
Period of Registration
*
Week 1: July 6 to 9
Week 2: July 13 to 16
Week 3: July 20 to 23
Week 4: July 27 to 30
Payment Plans:
*
Per Week - $ 12,500 JMD
Per Day - $ 4,000 JMD
I hereby certify that the above information is true to the best of my knowledge. **
REGISTER
