We need parent releases for all minors (under 18).

Registration is not complete until payment and all necessary paperwork has been received.

Registration Form

First Name:
Last Name:
Gender: Male Female
Email:
(this will also become your login if you need to make changes)
Phone:
Birthdate:
Registration Type:
Current Grade:
First time at WV
Church:
If other:

Mailing Address


If multiple students with the same address are registering, you may write "Same as [name of other student]"

Emergency Information

Emergency Contact Name:
Contact Phone:
Relationship:
Allergy and Medical Information:
Please provide all relevant medical information - including allergries, prescribed medications, or any other conditions we need to be aware of.

Health Insurance Information:
Please enter all relevant health insurance information including insurance provider, id number, policy number, etc.

Shirts and Photos:

Camp Photo:
T-shirt:
Note to staff: T-shirts are free for cabin leaders and core staff. You must still select a shirt size.

Bus Riders:

There are 6 seats remaining. Please help us offset the cost of the bus, and consider taking the bus if you can.
Bus Ride:
Person bringing student to bus pick up location:
Name:
Phone number:

Payment Info

Only payments by check will be accepted. Payments for multiple students can be made with one check.
Name on check:
Check Number:

Additional information

Enter any additional comments, requests, special instructions or other information that doesn't fit anywhere else.

(Optional) We can also send copies of confirmation emails to an additional email address:
Additional email:

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