Crooked Creek Christian Camp ALL OVERNIGHT CAMPERS

Please circle size: YS YM YL AS AM AL AXL AXXL GF/LF: ____________________
Grandfolks/Littlefolks (GFLF) Day campers may pre-order shirts for only $7 each by June 7. Indicate the number of shirts
you’d like and the size(s) on the above line. Add $7 per shirt to your camp fee. Additional shirts may be available for sale on
July 2, but with limited sizes.
Detach Form Here
ALL OVERNIGHT CAMPERS RECEIVE A FREE T-SHIRT
PARENTAL CONSENT (required for all overnight youth campers)
• If you do not want pictures including your child to be used for camp publicity (website, etc), please initial here: _______.
• In order to remain in compliance with certain government agencies, we are now required to report the following information:
My child qualifies for free or reduced lunch program at his/her school. (circle one) YES or NO
• I affirm that all information on this registration form is complete and accurate to the best of my knowledge. I hereby consent for my child to attend and participate in all activities provided by Crooked Creek Christian Camp.
Parent/Guardian Signature: ________________________________________ Date: ______________
A confirmation letter and health/medical release form will be mailed to you prior to your child’s camp.
CABIN MATE REQUESTS
In order to be considered, cabin mate request must meet these guidelines:
• You may request one person and the request must be mutual. (Both applicants must request each other)
• If you request more than one person, all requests will be disregarded. Camp will not be responsible for follow up. Please list your ONE cabin mate request here: ____________________
IMPORTANT DETAILS & INFORMATION
• Please submit your registration either online or via mail no later than one week prior to your child’s camp. If you miss the
deadline, call camp office for availability.
• With the exception of unexpected emergencies, campers are not permitted to leave camp for ball games or other activities
and return to camp. This can be very distracting to the growth and bonding that occurs at camp; please contact us with questions.
• Register Online! Check out our website, www.crookedcreekcamp.org for more information! You’ll find additional registration
forms, a Parent Page full of information about our activities, a general schedule, safety procedures and other helpful details.
• We accept credit cards! You can go to our website to register your child and take advantage of this option!
CAMPERSHIP FUND
If you would like to contribute to our campership fund to help others have the camping experience, please complete the
information: $__________: Contribution to Campership Fund
[ ] I am writing a separate check for this amount.
[ ] I am including this amount on the check I wrote for my child’s registration.
Please make checks payable to Crooked Creek Christian Camp.
MISSION STATEMENT
Crooked Creek Christian Camp serves the spiritual development of children and adults in the Midwest by providing Christcentered programs, excellent facilities, and generous hospitality in a setting that celebrates God’s Creation.
Crooked Creek
Christian Camp
2830 Coppock Road
Washington, IA 52353
319.653.3611
www.crookedcreekcamp.org
ccccamp@iowatelecom.net
2013 SUMMER CAMP REGISTRATION FORM
Summer camp is just around the corner and we want you
to experience the power of the upside down kingdom. The
upside down kingdom is a place where all are welcome,
all are cherished and all have a special place at the table.
Come and experience the love
of God and learn how to pass
that love on to others around
you. Enjoy nature, crafts,
games, music, worship, chapel,
campfire, swimming, great
food, meeting new people
and encountering God! For the
older kids we will also offer
the climbing wall, sleep-outs,
canoeing, tubing and cookouts.
Matthew 6:10, “Thy kingdom come, thy will be
done, on earth as it is in heaven…”
PARENTS
We place high importance on training our staff and
counselors to make sure they are prepared to meet the
needs of your child. While our main priority is your child’s
safety, we also intend on having a whole lot of fun!
SUMMER 2013 CAMP DATES
Register online or by filling out this form.
June 10 (9am) - June 11 (5pm) 1st & 2nd grade
June 12 (2pm) - June 14 (4pm) 3rd & 4th grade
June 16 (5pm) - June 21 (10:30am) 4th & 5th grade
June 23 (5pm) - June 28 (10:30am) 6th - 8th grade
July 7 (5pm) - July 12 (10:30am) 7th - 9th grade
July 18 (5pm) - July 21 (12pm) 10th & 11th grade
Camper Name: ________________________________________________________________________
(check one) My camper is a: [ ] first time camper [ ] returning camper
Camper birth date: (mm/dd/yyyy) _____________ Grade: (as of May 1, 2013) _____________ Gender: [ ] M [ ] F
Parent/Guardian: ______________________________________________________________________
Address: ________________________________ City/State/Zip: ________________________________
Phone: _________________________________ Cell: ________________________________________
Parent Email: ____________________________ Emergency Contact: _____________________________
Camper Church: ___________________________ Camper School: ________________________________
DISCOUNTS
Early Bird
Church
Bring a Friend
Camperships
Maximum for
Families
Send in your registration by May 13, 2013 and receive $5 off for a partial week or $10 for a full week of camp!
Some churches pay a portion of registration fees for members. Talk to your pastor to see if this applies to you!
Your church pays: _________________________________________.
Return campers, bring a friend who has never attended summer camp at CCCC before and get $10 off! Your
friend must attend the same week of camp as you and will be placed in your cabin. Bringing a friend will
take the place of a cabin mate request. Campers attending 1st & 2nd Grade camp are not eligible for this
discount. You must send ‘bring a friend’ registration in the same envelope. List name of new friend here:
___________________________.
Financial assistance through a Campership Fund is available to all who are in need. Simply complete this registration form and include a note to request financial assistance. Please indicate how much of the total fee you or your
church are able to pay; all inquiries are kept confidential.
Individual families sending more than one child to camp will not pay more than $575 in registration fees. Please
send all family registrations in the same envelope.
CAMP SESSION
**Grade level refers to the camper's grade as of May 1, 2013**
1st & 2nd Grade
June 10-11
$85
3rd & 4th Grade June 12-14 $120
4th & 5th Grade June 16-21
$200
6th-8th Grade June 23-28
$205
Grandfolk/Littlefolks Day July 2*
$21
7th-9th Grade July 7-12
$210
10th & 11th Grade (New!) July 18-21
$150
*Per person fee, not eligible for early bird discount.
FOR OFFICE USE ONLY:
Crooked Creek Christian Camp
2830 Coppock Road
Washington, IA 52353
www.crookedcreekcamp.org
CAMP FEES
$__________________ Camp cost
(Grand-Littlefolks only:
# of t-shirts ____ x $7 per shirt = ________)
45 Amount enclosed
less $____
($45 non-refundable deposit is due with each overnight
registration)
less $_________ Discount
(explain: _____________________________)
$_________ Total Due at the start of Camp
(may be paid in advance)
CONTINUED ON BACK SIDE