Camper's Name (required)

MaleFemale
Junior Counselor (age 10+)

Address
Home Phone (required)
Your Email (required)
Date of Birth
Age at camp
School grade in Sept 2023
Parent/guardian name and phone number
Parent/guardian name and phone number
Special needs: Allergies, educational needs, etc.)
Friend request (children are grouped by age, but we do our best to accommodate requests to be with a sibling or friend):
IN CASE OF EMERGENCY: if parent cannot be reached, contact (include phone number):
Please submit registration form along with fee by June 15. Fee can be paid online (see "Donate" button adjacent). Checks should be made out to Concord Church, memo: VBS 2022, and mailed to Concord Church, 1800 Fairfax Blvd, Wilmington, DE 19803,
ATT: Christina Pressley
Click the "Submit" button to register.

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