Mississippi Christian Service Camp
PO Box 6
Newton, MS 39345
Registration Form
Please complete a separate registration form for each week your child plans to attend camp.
Social Security number is for Insurance purposes only and is not disclosed to third parties or other
organizations.
Grade this fall:
Registration
Form
Campers Name:
Sex:
M
 F
Address:
Include City
State & Zip
Age:
Date of Birth:
E-mail Address:
Church I attend:
Phone Number of Church:
Immersed:
 Member:
Attended MCSC before?
Yes
No
 Week / Date I plan to attend:
If my child accepts Christ and desires baptism and I cannot be reached for confirmation, my permission
is:
Granted
Baptism
Denied
Baptism
Parent / Guardian Name (s):
Phones:
 (H)
(C)
(W)
Additional Contact:
Relationship to Camper:
Additional Contact Phone:
 (H)
 (W)
(C)
Photo Release
I give permission for Mississippi Christian Service Camp to use my child's photo on any promotional
material (printed or electronic).
Photo release
Parent's signature:
Date:
Dress Code / Code of Conduct
I have read the Camp's Dress Code Policy and Code of Conduct on MCSC web page.  I understand all
rules and penalties and will abide by them.
Date:
Camper's Signature:
Date:
Parent's Signature:
T - Shirt
Mark what size for T-Shirt.  No extra charge
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is
prohibited from discriminating on the basis of race, color, national origin, sex, age, or
disability.
Do not forget to fill out the health form as this is also necessary!!!
After this form has been submitted, use your browser button to go back to the camp page.
Registration cost is $90.00 per child. This fee only if we receive this by May 1, 2010.  After that date the
fee is $100.00.  This includes the cost of a camp picture and T-shirt, and for the canteen.
The only other money that the camper will need is for missions.