Camp Epworth Registration Form 2009

Return completed form and $10.00 fee to:

Teresa Gray, Director of Family Ministries

Epworth United Methodist Church

1030 Burrage Road, NE

Concord, NC  28025

Child’s Name:____________________________________________  Birthdate:__________

                              First Name                        Last Name

Address:__________________________City:_________________State:_______Zip:________

Phone Numbers:_____________________________________________________________

                                  Home                                         Work                                        Cell

Parents’/Guardians’ Name:__________________________________________

Email Address(es):___________________________________________________________

*Please check the week(s) and camp that your child will be attending.