Graceland University: Summer Camp Registry

Camp Registration

DIRECTOR INFORMATION
* Indicates items that are required.

Name*

Prefix First Last

Home Address

Street/Box Number

City State ZIP/Postal Code

E-mail Address* Home Phone*

Work Phone Cell Phone

Pager FAX

Best times to call (between) at home work
cell pager

(Assistant Director or other contact person)

Name
	Prefix	First	Last
Home Address
		Street/Box Number

	City		State	ZIP/Postal Code

	E-mail Address		Home Phone

	Work Phone		Cell Phone

	Pager		FAX
Best times to call (between) at			home work cell pager
Questions/Comments:

CAMP INFORMATION

Camp Type* Ages of Campers*

Sponsoring Jurisdiction(s)

Campground/Location*

Camp Address*

Street/Box Number

City* State* ZIP/Postal Code* Phone*

Starting Date*

Month Day Time

Ending Date*

Month Day Time

Staff needs to arrive early for staff training yes     no

If yes, when?

Special Needs (mark all that apply): Campfire        Counseling

Recreation

Other

I would prefer a female male

female or male more than 1 representative

Questions/Comments:

Best airport to fly into

Driving Directions
(from nearest airport/city)

When would be the most convenient time during the camp for the Graceland
Representative to give a presentation?

Questions/Comments:

Are there any special regulations, shots, or paperwork that Graceland Representatives
will need to comply with in order to attend your camp?*
Yes       No
If yes, what?: