-- AYC CAMP APPLICATION FORM --
Name_________________________________________________________________
Address_______________________________________________________________
City____________________________________ State__________________________
Phone No._________________________ Email Address_______________________
Parents' Names_________________________________________________________
Home Parish____________________________________________________________
What is your Priest's name?_______________________________________________
Birth Date______________ Age______ Grade in School:_______ Sex ( )Male ( ) Female
School you attend_______________________________________________________
Have you attended AYC Camp before?_________ If so, when?__________________
Do you have any condition which requires you to take medications?_____________
What medication(s) do you take?___________________________________________
State briefly why you wish to participate in the Anglican Youth Camp:____________
_______________________________________________________________________
________________________ ________________________________________
Date Applicant's Signature
Please enclose a pre-registration deposit of $25.00. This will be applied towards your enrollment contribution of $325.00 which offsets the expense of your week at Camp. Please notify us by June 30th if you cannot attend.
PLEASE MAIL THIS APPLICATION FORM BY JUNE 15TH T0:
ANGLICAN YOUTH CAMP
C/O ST. MARY OF THE ANGELS CHURCH
4510 FINLEY AVENUE
LOS ANGELES, CA 90027
Our phone, if you have any questions, is:
(323) 660-2700 (St. Mary's Church)
Or we may be contacted by email, at:
ALL APPLICATIONS MUST BE ACCOMPANIED BY THE PARENTAL CONSENT FORM, THE RECOMMENDATION FROM YOUR PARISH PRIEST, AND THE SIGNED YOUTH COVENANT.