Youth Ministry Summer Bible Camp Registration 2025

Registration fee $30 per student. Once you submit this form, please pay cash or make a check payable to “Saint George Church”. You may also call the rectory office at (814) 864-0622 to pay by credit/debit card (with an additional processing fee). Please email Roxanne at assistant@stgeorgeerie.org with any questions. Thank you!

"*" indicates required fields

Student Name*

First Last

Gender*

Grade (entering in Fall 2025)*

School*

Age*

Please enter a number from 3 to 14.

Birthdate*

Mother's Name*

First Last

Mother's Cell Phone Number*

Mother's Work Phone Number*

Mother's Email*

Father's Name*

First Last

Father's Cell Phone Number*

Father's Work Phone Number*

Father's Email*

Student's Primary Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Information*

Please list all allergies, medications, etc. for your child here. If you have any additional information that you would like us to know ahead of time, please write that here.

Additional Authorized Pick Up & Emergency Contacts*

At dismissal and/or in case of emergency, the following people are authorized to pick up my child. Please list at least one person aside from mom & dad.

Student's T-Shirt Size:

Youth Small

Youth Medium

Youth Large

Youth Extra Large

Adult Small

Adult Medium

Adult Large

Adult Extra Large