| Name : |
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| Parents Names : |
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| Email Address: |
(required) |
| Phone Number: |
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| Address : |
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| City : |
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State : |
Zip Code: |
| Sex : |
Age : |
| Present Grade Level : |
Date Of Birth : |
| Shirt Size : |
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Please consider my application for the ARTrageous Intensive
(ages 13-19 only) |
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Reference Information |
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This
information will be used to send the form to your reference, in order
to complete the application. Please fill out completely, failure to do
so will prolong the application process. |
| Name : |
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| Email Address: |
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| Phone Number: |
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| Address : |
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| City : |
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State : |
Zip Code: |
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Emergency Contact Information |
| Name : |
Phone : |
| Relationship to Participant : |
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Yes, I would like to serve as a chaperone for the ministry trip
Yes, if needed, I would be able to use my own vehicle to assist in
transportation for the ministry trip participations. |
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*Note:
There is a $20.00 non-refundable early registration fee ($30.00 after
May 31). Make checks payable to : Youth With A Mission and
mail to: Arts With A Mission Summer Camp • P.O. Box 132855 •
Tyler, TX • 75713-2855
*IMPORTANT:
Space for each age group is limited, so applications and registration
fees must be turned in as soon as possible! |
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| *Extra Forms to Download (PDF): |
Summer Camp Application with additional required forms. |
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