washington district youth camp

On-Line Registration Form

                Directions for Online Registration:
1. Fill out the form below and click "Submit" (Only one entry per person please)
2. Campers use PayPal button to submit payment. Note : If you have trouble with PayPal, you can come back
       to this page and simply choose the PayPal button to try again. No need to fill out form again)
3. If you register online, you must bring a signed Registration Form and a signed Recreation
     Waiver form with you to camp.

Name of Camper:

Age

Address:

Telephone #

Parent/Guardian Name:

Church Name/City:

Payment Method:

Camper Fee:
$250.00

PayPal

Check

Credit
Card

Forms for Printing

Note: Anyone wishing to be a counselor must fill out a background check form. We will contact you to
let you know if you have been approved. The background check form is mailed to:
Rev. Don Jacobsen, 216 North French St, Arlington, WA 98223. The Counselor Application form is
mailed to: Rev. Jeremy Painter, 7629 Oak Park DR NW, Bremerton, WA 98311

Registration form (.doc)	Registration form (.pdf)
Camp Rules & Regulations (.doc)	Camp Rules and Regulations (.pdf)
Camp Counselor Application form (.doc)	Camp Counselor Application form (.pdf)
Background check form (.doc)	Background Check form (.pdf)
Credit Card Pmt form (.doc)	Credit Card Pmt form (.pdf)
	R ecreation Waiver (pdf)

Payment Method
Check: Please include camper's names along with payment and mail to:
Youth Secretary, PO Box 3894, Silverdale, WA 98383.
PayPal: Please include a $3.00 fee per camper and also enter the names of the campers when
reviewing your payment in the "Name" area provided.
Credit Card: Please fill out separate credit card form and mail to Youth Secretary.