Summer Camp Registration Please enable JavaScript in your browser to complete this form. - Step 1 of 5How many campers are your registering? *12345How would you like to pay?I would like to pay only my deposit(s) todayI would like to pay in full todayNextCamper InformationCamper Name *FirstLastAge by CampCamper BirthdateCamper Sex *Choice 3MaleFemaleShirt Size $15 (Free if registered by June 1)Choice 10X-SmallSmallMediumLargeX-LargeXX-LargeTraditional Camps (Prices good thru 5/1) Early Registration DiscountJuly 3-8 -Youth Week1 {Solo} - $315.00* * Youth Week1 {With a buddy} - $285.00_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220.00July 10-15 - Teen Week (13-17yr) - $315.00July 17-22 - Youth Week 2 (8-13yr) - $315.00_ _ Day Camp 2 (8-13yr) - $220.00July 24-29 - Youth Week 3 (8-13yr) - $315.00_ _ Day Camp 3 (8-13yr) - $220.00July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315.00_ _ Day Camp 4 (8-13yr) - $220.00Aug 7-9 - Mini Camp (6-8yr) - $220.00_ _ Mini Day Camp (6-8yr) - $175.00Traditional Camps (Prices good thru 5/1) DEPoSIT ONLY $100/wkJuly 3-8 -Youth Week1 {Solo} - $315* * Youth Week1 {With a buddy} - $285_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220July 10-15 - Teen Week (13-17yr) - $315July 17-22 - Youth Week 2 (8-13yr) - $315_ _ Day Camp 2 (8-13yr) - $220July 24-29 - Youth Week 3 (8-13yr) - $315_ _ Day Camp 3 (8-13yr) - $220July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315_ _ Day Camp 4 (8-13yr) - $220Aug 7-9 - Mini Camp (6-8yr) - $220_ _ Mini Day Camp (6-8yr) - $175** Name of BuddyCabinmate RequestOutpost Camps (Prices good thru 5/1) Early Registration Discount July 10-15 - Gilrs Outpost 1 (10-12yr) - $315.00July 17-22 - Girls Outpost 2 (12-14yr) - $315.00July 24-29 - Boys Outpost 1 (10-12yr) - $315.00July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $315.00Outpost Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 10-15 - Gilrs Outpost 1 (10-12yr) - $315July 17-22 - Girls Outpost 2 (12-14yr) - $315July 24-29 - Boys Outpost 1 (10-12yr) - $315July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $315My child works with the following specialized Plan(s): Choose all that applyBehavioral PlanCare PlanDietary PlanTreatment PlanNone of the AbovePlease explain:Has the camper attended Cortland Bible Camp before? *YesNoHow did you hear about Cortland Bible Camp?2nd Camper Information2nd Camper - Name *FirstLast2nd Camper - Age by Camp2nd Camper - Birthdate2nd Camper - Sex *Choice 3MaleFemale2nd Camper - Shirt Size $15 (Free if registered by June 1)Choice 10X-SmallSmallMediumLargeX-LargeXX-Large2nd Camper - Traditional Camps (Prices good thru 5/1) Early Registration Discount July 3-8 -Youth Week1 {Solo} - $315.00* * Youth Week1 {With a buddy} - $285.00_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220.00July 10-15 - Teen Week (13-17yr) - $315.00July 17-22 - Youth Week 2 (8-13yr) - $315.00_ _ Day Camp 2 (8-13yr) - $220.00July 24-29 - Youth Week 3 (8-13yr) - $315.00_ _ Day Camp 3 (8-13yr) - $220.00July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315.00_ _ Day Camp 4 (8-13yr) - $220.00Aug 7-9 - Mini Camp (6-8yr) - $220.00_ _ Mini Day Camp (6-8yr) - $175.002nd Camper - Traditional Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 3-8 -Youth Week1 {Solo} - $315* * Youth Week1 {With a buddy} - $285_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220July 10-15 - Teen Week (13-17yr) - $315July 17-22 - Youth Week 2 (8-13yr) - $315_ _ Day Camp 2 (8-13yr) - $220July 24-29 - Youth Week 3 (8-13yr) - $315_ _ Day Camp 3 (8-13yr) - $220July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315_ _ Day Camp 4 (8-13yr) - $220Aug 7-9 - Mini Camp (6-8yr) - $220_ _ Mini Day Camp (6-8yr) - $175** 2nd Camper - Name of Buddy 2nd Camper - Cabinmate Request2nd Camper - Outpost Camps (Prices good thru 5/1) Early Registration Discount July 10-15 - Girls Outpost 1 (10-12yr) - $315.00July 17-22 - Girls Outpost 2 (12-14yr) - $315.00July 24-29 - Boys Outpost 1 (10-12yr) - $315.00July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $315.002nd Camper - Outpost Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 10-15 - Girls Outpost 1 (10-12yr) - $315July 17-22 - Girls Outpost 2 (12-14yr) - $315July 24-29 - Boys Outpost 1 (10-12yr) - $315July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $3152nd Camper My child works with the following specialized Plan(s): Choose all that applyBehavioral PlanCare PlanDietary PlanTreatment PlanNone of the Above2nd Camper Please explain:2nd Camper -Has the camper attended Cortland Bible Camp before? *YesNo3rd Camper Information3rd Camper - Name *FirstLast3rd Camper - Age by Camp3rd Camper - Birthdate3rd Camper - Sex *Choice 3MaleFemale3rd Camper - Shirt Size $15 (Free if registered by June 1)Choice 10X-SmallSmallMediumLargeX-LargeXX-Large3rd Camper - Traditional Camps (Prices good thru 5/1) Early Registration Discount July 3-8 -Youth Week1 {Solo} - $315.00* * Youth Week1 {With a buddy} - $285.00_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220.00July 10-15 - Teen Week (13-17yr) - $315.00July 17-22 - Youth Week 2 (8-13yr) - $315.00_ _ Day Camp 2 (8-13yr) - $220.00July 24-29 - Youth Week 3 (8-13yr) - $315.00_ _ Day Camp 3 (8-13yr) - $220.00July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315.00_ _ Day Camp 4 (8-13yr) - $220.00Aug 7-9 - Mini Camp (6-8yr) - $220.00_ _ Mini Day Camp (6-8yr) - $175.003rd Camper - Traditional Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 3-8 -Youth Week1 {Solo} - $315* * Youth Week1 {With a buddy} - $285_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220July 10-15 - Teen Week (13-17yr) - $315July 17-22 - Youth Week 2 (8-13yr) - $315_ _ Day Camp 2 (8-13yr) - $220July 24-29 - Youth Week 3 (8-13yr) - $315_ _ Day Camp 3 (8-13yr) - $220July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315_ _ Day Camp 4 (8-13yr) - $220Aug 7-9 - Mini Camp (6-8yr) - $220_ _ Mini Day Camp (6-8yr) - $175** 3rd Camper - Name of Buddy 3rd Camper - Cabinmate Request3rd Camper - Outpost Camps (Prices good thru 5/1) Early Registration Discount July 10-15 - Girls Outpost 1 (10-12yr) - $315.00July 17-22 - Girls Outpost 2 (12-14yr) - $315.00July 24-29 - Boys Outpost 1 (10-12yr) - $315.00July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $315.003rd Camper - Outpost Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 10-15 - Girls Outpost 1 (10-12yr) - $315July 17-22 - Girls Outpost 2 (12-14yr) - $315July 24-29 - Boys Outpost 1 (10-12yr) - $315July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $3153rd Camper My child works with the following specialized Plan(s): Choose all that apply *Behavioral PlanCare PlanDietary PlanTreatment PlanNone of the Above3rd Camper Please explain:3rd Camper - Has the camper attended Cortland Bible Camp before? *YesNo4th Camper Info4th Camper - Name *FirstLast4th Camper - Age by Camp4th Camper - Birthdate4th Camper - Gender *Choice 3MaleFemale4th Camper - Shirt Size $15 (Free if registered by June 1)Choice 10X-SmallSmallMediumLargeX-LargeXX-Large4th Camper - Traditional Camps (Prices good thru 5/1) Early Registration Discount July 3-8 -Youth Week1 {Solo} - $315.00* * Youth Week1 {With a buddy} - $285.00_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220.00July 10-15 - Teen Week (13-17yr) - $315.00July 17-22 - Youth Week 2 (8-13yr) - $315.00_ _ Day Camp 2 (8-13yr) - $220.00July 24-29 - Youth Week 3 (8-13yr) - $315.00_ _ Day Camp 3 (8-13yr) - $220.00July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315.00_ _ Day Camp 4 (8-13yr) - $220.00Aug 7-9 - Mini Camp (6-8yr) - $220.00_ _ Mini Day Camp (6-8yr) - $175.004th Camper - Traditional Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 3-8 -Youth Week1 {Solo} - $315* * Youth Week1 {With a buddy} - $285_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220July 10-15 - Teen Week (13-17yr) - $315July 17-22 - Youth Week 2 (8-13yr) - $315July 17-22 - Youth Week 2 (8-13yr) - $315_ _ Day Camp 2 (8-13yr) - $315July 24-29 - Youth Week 3 (8-13yr) - $315_ _ Day Camp 3 (8-13yr) - $315July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315_ _ Day Camp 4 (8-13yr) - $315Aug 7-9 - Mini Camp (6-8yr) - $315_ _ Mini Day Camp (6-8yr) - $175** 4th Camper - Name of Buddy 4th Camper - Cabinmate Request4th Camper - Outpost Camps (Prices good thru 5/1) Early Registration Discount July 10-15 - Girls Outpost 1 (10-12yr) - $315.00July 17-22 - Girls Outpost 2 (12-14yr) - $315.00July 24-29 - Boys Outpost 1 (10-12yr) - $315.00July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $315.004th Camper - Outpost Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 10-15 - Girls Outpost 1 (10-12yr) - $315July 17-22 - Girls Outpost 2 (12-14yr) - $315July 24-29 - Boys Outpost 1 (10-12yr) - $315July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $3154th Camper My child works with the following specialized Plan(s): Choose all that apply *Behavioral PlanCare PlanDietary PlanTreatment PlanNone of the Above4th Camper Please explain:4th Camper - Has the camper attended Cortland Bible Camp before? *YesNo5th Camper Information5th Camper - Name *FirstLast5th Camper - Age by Camp5th Camper - Birthdate5th Camper - Sex *Choice 3MaleFemale5th Camper - Shirt Size $15 (Free if registered by June 1)Choice 10X-SmallSmallMediumLargeX-LargeXX-Large5th Camper - Traditional Camps (Prices good thru 5/1) Early Registration Discount July 3-8 -Youth Week1 {Solo} - $315.00* * Youth Week1 {With a buddy} - $285.00_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220.00July 10-15 - Teen Week (13-17yr) - $315.00July 17-22 - Youth Week 2 (8-13yr) - $315.00_ _ Day Camp 2 (8-13yr) - $220.00July 24-29 - Youth Week 3 (8-13yr) - $315.00_ _ Day Camp 3 (8-13yr) - $220.00July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315.00_ _ Day Camp 4 (8-13yr) - $220.00Aug 7-9 - Mini Camp (6-8yr) - $220.00_ _ Mini Day Camp (6-8yr) - $175.005th Camper - Traditional Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 3-8 -Youth Week1 {Solo} - $315* * Youth Week1 {With a buddy} - $285_ _ DAY Camp 1 (8-13yr) Note* NOT Overnight - $220July 10-15 - Teen Week (13-17yr) - $315July 17-22 - Youth Week 2 (8-13yr) - $315_ _ Day Camp 2 (8-13yr) - $220July 24-29 - Youth Week 3 (8-13yr) - $315_ _ Day Camp 3 (8-13yr) - $220July 31 - Aug 5 - Youth Week 4 (8-13yr) - $315_ _ Day Camp 4 (8-13yr) - $220Aug 7-9 - Mini Camp (6-8yr) - $220_ _ Mini Day Camp (6-8yr) - $175** 5th Camper - Name of Buddy5th Camper - Cabinmate Request5th Camper - Outpost Camps (Prices good thru 5/1) Early Registration Discount July 10-15 - Girls Outpost 1 (10-12yr) - $315.00July 17-22 - Girls Outpost 2 (12-14yr) - $315.00July 24-29 - Boys Outpost 1 (10-12yr) - $315.00July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $315.005th Camper - Outpost Camps (Prices good thru 5/1) DEPOSIT ONLY $100/wkJuly 10-15 - Girls Outpost 1 (10-12yr) - $315July 17-22 - Girls Outpost 2 (12-14yr) - $315July 24-29 - Boys Outpost 1 (10-12yr) - $315July 31 - Aug 5 - Boys Outpost 2 (12-14yr) - $3155th Camper My child works with the following specialized Plan(s): Choose all that apply *Behavioral PlanCare PlanDietary PlanTreatment PlanNone of the Above5th Camper Please explain:5th Camper - Has the camper attended Cortland Bible Camp before? *YesNoPreviousNextEmergency Contact InformationPlease enter the name of the parent or guardian who should be contacted in the case of an emergency.Relationship *ParentSiblingRelativeFriendName *FirstLastEmail *Phone *Phone (2)AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAdditional Comments or RequestsPreviousNextCortland Bible Camp Health FormPlease fill out, sign, and return the Health Form for each registered camper. You may either upload the completed documents below or click next and mail them in separately from this application.Completed Health Form Click or drag files to this area to upload. You can upload up to 5 files. PreviousNextParent AuthorizationThis Camper has my permission to participate in all camp activities, except as noted on the medical form. I hereby give permission for the camp to provide ongoing and routine healthcare, to administer prescribed medications and seek emergency medical treatment including to order X-rays, routine tests, treatment, and necessary transportation for my child. I give permission to teh camp to release any records necessary for insurance purposes. In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the camp director to secure and anminister treatment, including hospitalization for my child. I give my permission to the officials at camp to take still, video and digital pictures of my child for the use of the camp in promotional publications, print, video, and World Wide Web.Date / TimeDateTimeFull Name Clear Signature PaymentYou will be transferred to PayPal in order to complete your payment. Total$0.00Square *CardName on CardDate / TimeDateTimeSubmit