Student Name *

First Name

Last Name

Guardian Name *

First Name

Last Name

Guardian Phone *

(###)

###

####

Please write a check for down payment with "Summer Camp -Student's Name-" in notes. For the check, I prefer to... *

Hand deliver to Pastor Ryan or Pastor Harold

Mail in to Asbury (Asbury UMC, 6101 University Ave, Madison, WI, 53705, ATTN: Summer Camp)