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2024 AKROS Registration Form

June 10 - 15, 2024 - Grades 2nd - 6th Grades 7th - 12th / $175 (before May 1st*) - $200 (after May 1st) - Must be sent in before or postmarked May 1st, 2024 (no later) - Multi-Family discounts available for immediate family members only - Limited scholarships available, please call for more details. - PLEASE NOTE: You can send in your deposit/camp fee, or pay online (there is a $5 online processing fee)

Camper's Name: *

Parent / Guardian Name: *

Parent's Email Address: *

Camper's Email Address: *

Home Number: *

Mobile Number: *

Camper's Address: *

Parent's Address: *

Camper's Birthday: *

Grade going into fall 2024: *

Camper's First Time *

Camper's Gender *

Youth T-Shirt Size: *

Adult T-Shirt Size: *

Cabin Mate Request:

Camper's Church:

Pastor's Name:

Mother's Name: *

Father's Name: *

Mother's Date of Birth: *

Father's Date of Birth: *

Father's Employment *

Mother's Employment *

Mother's Work Phone: *

Father's Work Phone: *

Insurance Company: *

Insurance Group Number: *

Insurance Personal Number *

Drug / Food / Other Allergies: *

Current Medications: *

Are the camper's vaccinations current: *

Other Medical / Personal Info:

Emergency Contact Name: *

Phone Number: *

$175 (By May 1, 2024) *

$200 (After May 1, 2024) *

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