Children's Mission Camp Hold Form 2018

Church Name*

Church Billing Address*

Street Address City State ZIP Code

Parish / County*

Church Phone*

Church Email (if no email, type none)*

Has your church been to Tall Timbers for camp before?*

Primary Contact*

Your gender:*

Permanent Address*

Street Address City State ZIP Code

Parish / County*

Church Employee or Church Contact?*

Your Title:

Date of Birth (to avoid duplicate names in online system)*

Primary Cell Phone*

Your Email (if no email, type none)*

How many spots are you reserving for camp?

Number of male chaperones

Number of male students

Number of female chaperones

Number of female students

Choose Yes or No to Lee Lodge preference:*

Choose from the following:

Please explain:

Please choose one security question of your choice for us to set up your online registration and provide the answer below:*

Answer:*