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PLEASE KEEP THIS SECTION July 5-9, 2011 $84.00 camp fee, payable first day of camp $10.00 preregistration fee $94.00 total cost: $10.00 preregistration + $84 camp fee

Junior Week Grades 3-6 The Him Lord r e by th self...in veale d Lor e Wo Shilo h d. r I Sa d of th e m. 3:2 1

Beginning and ending times: Junior Week: Tuesday — 3:00 PM - 4:30 PM Registration 4:30 PM Organizational Meeting

Junior High Week July 11-16, 2011 $89.00 camp fee, payable first day of camp Grades 6-9

Junior High Week: Monday — 3:00 PM - 4:30 PM Registration 4:30 PM Organizational Meeting

$10.00 preregistration fee $99.00 total cost: $10.00 preregistration + $89 camp fee

What to bring:

Bible, notebook & pen, sleeping bag and pillow, towels, washcloths and soap, toothbrush and toothpaste One-piece swimsuit (modest)

Saturday, 9:30 AM — camp ends for both weeks

Colored T-shirt (for swimming) Sports clothes (Girls may wear slacks or dresses - all sports clothes must be modest) All garments must be loose fitting, no tank tops, shorts must be within a hand width of knee

Optional things to bring: Canteen, offering money, musical instruments, fishing pole, ball gloves What to leave home: Secular magazines; personal electronics; T-shirts with rock music, beer or movie themes; ear rings or neck jewelry for boys; knives or other weapons

Detach Here Last

REGISTRATION FORM

Detach Here

First

Name

Male ( ) Female ( )

Street

Phone

City Age

State Birth date

Church

Zip

CHECK YOUR CAMP ( ) Junior High Grades 6-9 ( ) Junior Camp Grades 3-6 (grades going into)

School Grade this fall City

Parents or Guardian

Camp Use Only

Today’s Date

Please: Fill out this form completely and include the $10.00 preregistration fee. Return this form and above fee to your pastor. Pastors, send forms to: Pastor Marlon Mielke, First Baptist Church • Box 129 • Milltown, WI 54858 Make checks payable to: Camp Shiloh Registration deadline: Postmarked by May 19, 2011 - Junior $10 late fee for missing the deadline May 19, 2011 - Jr. High $5 canteen credit for early registration or a free Camp Shiloh T-shirt Cabin Mate? Medical information: *History of Allergies? Diabetes? Rheum, Fever? Any Chronic Disease or Med. info ? *(Explanations) Insurance Policy Policy # Last Tetanus Shot given: Any medication being taken: List names - dosage and reason for taking: I authorize the medical personnel at Camp Shiloh to give any attention deemed necessary to: Name of Camper During the week of: I also give permission for non-prescription medication to be given for minor illnesses, at the nurse’s discretion. Signature of Guardian

The Him Lord r e by t self...i veale n d h Lor e Wo Shilo h d. rd o I Sa f m. the 3:2 1

Date

*Please send meds to camp in original bottles with instructions on them.

■ Upon signing this form you agree to allow picture, video, and audio of your children to be used in the Week of Camp DVD. If you do not agree, please check this box and your child will not appear in the Week of Camp DVD.

Shiloh Flyer p 2 2011