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WCKCM 2024

Leaders Registration

Name

First Name

Last Name

Age

Phone

(###)

###

####

Home Church

Department

Any allergies, medications, or medical conditions?

If none, write "none"

Will your parents be at camp meeting?

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

###

####

If you’re over 18, have you completed the voluntary safety requirements for your home church? Please submit your certificate or a letter from your pastor certifying you.

If YES, send a photo or a copy of the letter from your pastor to rocfellowshipsda@gmail.com