Which camp are you registering for? *

Camper's Name *

Camper's Name

First Name

Last Name

Age of Camper *

Grade *

Gender *

Home Church

Cabinmate Request

Medical Dietary Restrictions

Serious allergies only. Note: Shiloh does NOT provide any lactose free milk products or specialty bread.

Parent/Guardian's Name

First Name

Last Name

Email Address *

Mailing Address *

Phone *

Phone

Please put the best number at which we can reach you.

(###)

###

####

Alternate Phone

(###)

###

####

Lice Checks *

I understand that Lice checks will be administered at registration and the camper could be SENT HOME if lice are found.

Yes, I understand.

Dress CodeMedical *

I have read and agree to follow Shiloh's Dress Code.

Yes, I have.

Payment Method *

Please specify which payment method you will choose below.

Don't forget your Medical release form! Click here to download.