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STEM Application

CHISHOLM TRAIL SUMMER CAMP APPLICATION

This application is to register your child into this year's camp. A separate application is required for each child.

Student Information

Name(Required)

First Last Suffix

Gender(Required)

Age(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Grade(Required)

1st

2nd

3rd

4th

School(Required)

Race(Required)

American Indian or Alaskan Native

Asian

Black/African American

Latino/a

Native Hawaiian or Pacific Islander

White

Other

List any allergies/medical conditions:

Child's T-Shirt Size(Required)

Youth Small

Youth Medium

Youth Large

Youth XL

Parent/Guardian Information

Email(Required)

Enter Email Confirm Email

Name(Required)

First Last Suffix

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Phone Type(Required)

Home

Cell

Place of Work:

Work Phone

Emergency Contact(Required)

First Last

Phone(Required)

Pick-up List (Other than parent/guardian)

Name

First Last

Phone

Special Instructions(Required)

Yes

Are there any special instructions for the staff or anything that the staff should now about your child?

Demographics

For our records and sponsors of the program, we must show the demographics of children being served by the program.

Marital Status(Required)

Married

Single

Divorced

Widowed

What range is your total household income?(Required)

Less than $10,000

Between $10,001 and $20,000

Between $20,001 and $30,000

Between $30,001 and $40,000

Between $40,001 and $50,000

Between $50,001 and $60,000

Between $60,001 and $70,000

Between $70,001 and $80,000

Between $80,001 and $90,000

Between $90,001 and $100,000

Over $100,000

Does your child qualify for free or reduced lunch?(Required)

Yes (Free Lunch)

Yes (Reduced Lunch)

Yes (Free and Reduced Lunch

No (Does not qualify for Free or Reduced Lunch)

How much adults reside in your household?(Required)

CAMP DETAILS

PHOTO RELEASE

I hereby grant and authorize Harvest Plenty House of Prayer Church undefined the right to take, edit, copy, publish, distribute and make use of any and all pictures or video taken of my child to be used in and/or for legally promotional materials and digital communications. This authorization shall continue indefinitely unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of Harvest Plenty House of Prayer Church and will not be returned.(Required)

I have read the above and agree

LIABILITY WAIVER

I release Harvest Plenty House of Prayer Church and all partnering entities from liabilities, penalties, expenses, legal fees and costs of any kind or amounts whatsoever, which result from my child participating in the Chisholm Trail Summer Camp.(Required)

I have read the above and agree

How did you hear about this camp?(Required)

REGISTRATION INFORMATION

The cost of this 4-week Summer Camp is $200 per child.

I understand that in order for my application to be completed and my child to be enrolled in the Chisholm Trail Summer Camp, registration fees must be paid to Harvest Plenty House of Prayer Church. Registration fees are non-refundable even if my child attends some, partial or none of the days of the camp. I understand that if my child is removed from the camp because of behavioral issues, registration fees are forfeited and will not be returned.(Required)

I have read the above and agree

Registration Fee

Price:

Electronic Signature(Required)

Please enter your full name.

"It is more blessed to give than to receive" — Acts 20:35

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Connect With Us

580-248-2317

harvestplentyhop@gmail.com

Location: 3826 SE Elmhurst Lane Lawton, OK

Mailing Address: P. O. Box 841 Lawton, OK 73502

STEM Application

CHISHOLM TRAIL SUMMER CAMP APPLICATION

Student Information

Parent/Guardian Information

Pick-up List (Other than parent/guardian)

Demographics

CAMP DETAILS

PHOTO RELEASE

LIABILITY WAIVER

REGISTRATION INFORMATION

"It is more blessed to give than to receive" — Acts 20:35

Links

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