2014 TN Middle School Leadership Camp
Transcription
2014 TN Middle School Leadership Camp
D.O.B. _____ / _____ / _____ JU LY 3 0 RU TH E3 Jackson: David Hicks 731-234-4165 Johnson City: Steve McAuley 423-306-4889 Kingsport: Marsha Barnes 423-765-7316 Knoxville: Dean Craig 865-524-6076 Lakeway: Scott Galyon 865-712-6619 Memphis: Larry Coley 901-683-3399 Murfreesboro: Brian Harrell 615-426-1995 Nashville: Mark Wracher 615-889-8808 NW TN: Barry Duncan 731-446-1710 AGE: _______ PHONE: ( _____ ) _____ - _______ CITY: _____________________ STATE: ____ ZIP: ________ ADDRESS: _______________________________________ JU N EMAIL: _________________________________________ WORK PHONE: ( _____ ) _____ - _______ CELL PHONE: ( _____ ) _____ - _______ HOME PHONE: ( _____ ) _____ - _______ NAME: _________________________________________ SCHOOL (NO ABBREV.): ______________________________ GRADE IN FALL: ________ GENDER: MALE / FEMALE CAMPER NAME: __________________________________ CAMPER INFORMATION REGISTRATION FORM (SIDE 1 OF 2) P M CA L Hendersonville: Jason McCormick 615-217-7700 IP Greeneville: Larry Bible 423-329-7320 SH OO Clarksville: Gary Rankhorn 931-503-3284 ER CH CONTACT YOUR LOCAL FCA TO REGISTER! Chattanooga: Jay Fowler 423-877-3561 AD FOR MORE DETAILS PLEASE CONTACT CAMP DIRECTOR BEN GOOCH: (931)477-0306, BGOOCH@FCA.ORG LE Rooming is dorm-style and all meals during camp will be provided. FELLOWSHIP OF CHRISTIAN ATHLETES S LE CHOOSE: MR. / MRS. / MS. PACKING LIST Bedding (pillow, twin-size sheets, sleeping bag) Towels & Toiletries Athletic Shoes, Extra Clothes & Swim Suit (1-piece) DD CHOOSE: PARENT / GUARDIAN FCA MIDDLE SCHOOL LEADERSHIP CAMP IS OPEN FOR STUDENTS ENTERING 6TH GRADE THROUGH ENTERING 9TH GRADE MI PARENT/GUARDIAN INFORMATION CAMP DETAILS Ocoee Region: Robert Green 423-284-0105 Smoky Mtn Area: Steve Llewellyn 615-785-2018 SW Middle TN: Ben Gooch 931-477-0306 Upper Cumberland: Noel Cherry 931-372-2123 COVENANT COLLEGE 14049 SCENIC HIGHWAY LOOKOUT MOUNTAIN, GA 30750 REGISTRATION FORM (SIDE 2 OF 2) REGISTRAIONT DETAILS PLEASE TURN IN REGISTRATION FORM AND PAYMENT TO YOUR LOCAL FCA OFFICE. CONTACT INFORMATION FOR EACH OFFICE IS LOCATED ON THE BACK OF THIS BROCHURE. It is an overnight camp at Covenant College for students entering the 6th-9th grades. Campers will learn leadership skills to help lead FCA at their schools. Of course everything will be done in awesome FCA style including: sports competitions, crazy games, new friendships, and great worship. Can’t wait to see you there! IF YOU NEED A SCHOLARSHIP, CONTACT YOUR LOCAL FCA OFFICE TO SEE IF ANY ARE AVAILABLE. PAYMENT INFORMATION AMOUNT INCLOSED ($100 DOWN-PAYMENT REQUIRED: _______________ Discover / VISA / MasterCard / Am.Expr. FCA SCHOLARSHIP AMOUNT: _______________ □ CASH □ CHECK □ CARD (CIRCLE CARD TYPE): CARD #: ____________________________________ EXP DATE: ___ / ______ CARD HOLDER NAME: _____________________________________________ BILLING ADDRESS: ________________________________________________ Camp Pastor UTC Wrestling Head Coach HEATH ESLINGER PLEASE LIST ANY SPECIAL DIETARY NEEDS OR FOOD ALLERGIES WHAT IS THE COST FOR FCA CAMP? PARENT/GUARDIAN SIGNATURE: ____________________________________ Worship Leader Atlanta, GA We will try our best to accommodate! Camp Pastor Bridge Fellowship: Mt. Juliet PHIL WILSON ● FCA “ALL IN” T-SHIRT ● FCA “ALL IN” LANYARD ● 2014 FCA BIBLE ● NEW FRIENDS ● GREAT MEMORIES JAKE GULLEDGE WHAT DO YOU GET AT FCA MIDDLE SCHOOL CAMP? $230 WHAT IS MIDDLE SCHOOL LEADERSHIP CAMP?
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