iLift 2009 - Camp Registration

Church Information

Oak Hill Baptist Church
2135 Oak Hill Road
Somerset, KY 42503

Camp Location

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Camper Information


First Name*
Last Name*
Primary Email* (used for login soon)

Home Address 1*
Home Address 2
City*
State*
Zip Code*
Area Code - Phone*	###-###-####
Area Code - Cell Phone	###-###-####

Date of Birth*	mm/dd/yy
Gender*	Male Female
Registration Type*	Camper Adult

Emergency Information

Parent/Guardian's First Name*
Parent/Guardian's Last Name*
Relationship*

Emergency Contact First Name*
Emergency Contact Last Name*
Emergency Phone*
Emergency Phone (alternate)

Medical Insurance Company*
Policy Number*

Additional Information

Expected year of graduation
Expected year to start college
College of interest
Major of interest
Keep my information private from colleges & universities

Northeast and East camps please call (or email) for availability 703-217-0897 (KarenF@liftstudentministries.com).

Printable Required Waiver form