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2010 Power Camp Registration By Check
Camper Information
Camper Name
Gender
Male
Female
Camper Age
Grade Last Completed*
T-Shirt Size*
YS
YM
YL
YXL
Adult-S
Adult-M
Parent Information
Parent Name*
Address*
Address (cont.)
City*
State*
Zip*
Evening Phone Number*
Daytime Phone Number*
Email*
Please list any allergies or medications that your child is currently taking
Emergency Contact Name*
Emergency Contact Number*
Camp Information
Preferred Week:
June 7-11 at Catawba Baptist
June 14-17 at Dutchman Creek Middle
Sport (Choose One):*
Football
Basketball (Co-Ed)
Baseball (Bring your own glove)
Soccer (Co-Ed)
Cheerleading
Volleyball (3rd-5th Grade Only)
Payment Information
Pricing Level
Camper Fee | $60
Camper Fee and DVD | $70
Please make checks payable to FCA and mail to: 452 Lakeshore Pkwy., Suite 205 Rock Hill, SC 29730
If you have any questions or need additional information, please call the local FCA office at 803-327-8512
* indicates a required field
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