Name: Phone:

Street: City: State: Zip:

Birthday: T-Shirt Size: (Choose child 14/16 or adult small to XXLarge)

School: Grade: Only students completing 7th grade can attend camp.

I attend church. Email address:

Emergency contact person: Emergency phone if my parents cannot be reached:

I have my parent's consent (if under the age of 18) to attend the First Baptist Church of Fenton Youth Camp at Logan Valley.

Yes No

Deposit of $30 is due to Associate Pastor Terry Coker by May 18. Please mail check to: First Baptist Church, ATTN: Terry Coker, 650 Oakwood Dr., Fenton, MO 63026. We will acknowledge the receipt of your deposit and send you more information about the camp. You will also need a signed and notarized medical release form on file.