Registration
Please print this page, fill it out, then mail with deposit to:
Burke
Brack/Singles Minister; 3500 Golf Course Road;
Midland, TX; 79703
A Camper’s Packet will be sent to you and your family
with detailed information when we receive your deposit.
If you have questions, please contact Burke Brack or
Cathy Aduddell
by email or by calling 432-694-8836.
Parent's Information
First name Last
Name
M / F (circle) T-shirt size: _____
Street Address
City State
Zip
Phone ( ) Email
I am…
Divorced Widowed
Never married
Custodial parent My
children do not live with me
Payment Information
Cost per camper is $100.00. A
NON-REFUNDABLE deposit of $100.00
will be applied
towards one member of your family.
Deposit only Paying in full
Cash Check Check #
Child(ren)’s Information
SPFC is designed
for kids entering grades pre-K (4 years old) through teens who
have just
completed their senior year of High School.
First name Last
Name
M / F (circle) Age
Grade (2009-2010 school year) T-shirt
size: _____
First name Last
Name
M / F (circle) Age
Grade (2009-2010 school year) T-shirt
size: _____
First name Last
Name
M / F (circle) Age
Grade (2009-2010 school year) T-shirt
size: _____
First name Last
Name
M / F (circle) Age
Grade (2009-2010 school year) T-shirt
size: _____
First name Last
Name
M / F (circle) Age
Grade (2009-2010 school year) T-shirt
size: _____
First name Last
Name
M / F (circle) Age
Grade (2009-2010 school year) T-shirt
size: _____