Summer 2025 Template

WESTERN RESERVE

CAPERNAUM SUMMER CAMP

2025 Rockbridge Wk 12 - OH34

WHERE: Rockbridge Alum Springs

WHEN: August 02, 2025 - August 06, 2025

Departure: August 02, 6:00 am

Return: August 06, evening

COST:

Camper: $795

Buddy: $250

Money is nonrefundable after April 1.

After completing this form, a confirmation will be sent with the information you have entered below.

Questions and Information

Laurie Stuursma | 330.618.2847 | [email protected]

Mark Eger | 937.232.3013 | [email protected]

Participant Information

Guest Type*

Registration Options*

CAMPER: Register with a deposit or full payment ($795.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
CAMPER: Register with an offline payment/$0 deposit ($795.00)
To register without credit card information, select cash/check/offline. This option will also create a payment link for the full balance listed.
BUDDY: Register with a deposit or full payment ($250.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
BUDDY: Register with an offline payment/$0 deposit ($250.00)
To register without credit card information, select cash/check/offline. This option will also create a payment link for the full balance listed.

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Participant Address*

Gender*

Male
Female

Additional Comment

Ethnicity*

T-shirt Size

School

High School Graduation Year*

Additional Comments

Parent / Guardian Information

Parent/Guardian Name*

Parent/Guardian Phone*

Phone Type*

Parent/Guardian Email*

Address is same as participant

Address*

Would you like to cover the 2.5% credit card processing fee?*

Total

$0.00

Billing Information

Email*

Name*

Payment Method

Credit Card
Cash/Check/Offline

Credit Card*

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Address*

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