Youth Registration

 


Please print. Use one form per program and person. Send this form with

deposit ( make checks payable to Hope Center) to:

Hope Center, P.O. Box 165, Hope NJ  07844

 

Name_____________________________________________________________

Registering for (Program)_____________________________________________ Youth Registration

Youth RegistrationYouth RegistrationM    F     Age_____ Grade Completed_____  Birth Date____/____/______

Parent/Guardian____________________________________________________

Address____________________________________________________________

City___________________________________ State ________Zip_____________

Day Phone (____)___________________Evening Phone (____)_____________

Cell Phone (____)___________________

EMAIL REGISTRATION CONFIRMATION:  

       ◊ I will accept email registration confirmation with forms attached  ◊ Word  ◊ tiff file 

         Family Email  Address: ___________________________________________

Camper's email address  _______________________________________________

Home Church & Denomination_________________________________________

City_______________________________________ State_____________________

Roommate Request (one please)________________________________________

 I have recruited this person(s) for a summer  conference or camp.

(Attach a sheet with up to five names)

Name__________________________________ Program_______________________

† As a new Hope Center camper, I was recruited by _________________________

     who is registered in (Program name)____________________________________

 

1. Total fee before discount                +              $__________________

2. Store Deposit (optional)                  +              $__________________

3. Early Registration discount             -               $__________________

4. Recruiter Discount                           -               $__________________

5. Other Discount ___________          -               $__________________

6. Deposit (ck #_________)                 -               $__________________

7. Balance Due                                      =              $__________________