2010 NeSoDak Day Camp Application

Name of Congregation *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Pastor's Name First Last
Church Phone * - (###) - ### ####
Name of Day Camp Coordinator * First Last
Contact Person
Home Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Email
Initial Estimate of Number of Youth *

(Firm number is not required until 10 days before Day Camp begins)
Type of Day Camp * Congregational Day Camp Community-Wide Day Camp
Please choose your first, second and third choice of weeks.
First Choice *
Second Choice *
Third Choice *
Comments or Questions