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Camper Registration

Complete the form below, as well as the following forms, and you will be contacted by one of our representatives in regards to your registration request. You must be the camper's parent or guardian to submit a registration on their behalf.

Camper Information

First Name:

Last Name:

Street Address:

City:

State:

Zip:

E-mail Address:

Grade Entering in Fall:

Birth Date (mm-dd-yyyy):

Previously at Camp Jabez:

T-Shirt Size*:

**Due to activities, t-shirt size must be accurate - not over-sized.

Camp Preference

Please indicate the camp that you would like to attend.

First Choice:

Second Choice:

H1 = Horse/Level I**H2 = Horse/Level II**
H3 = Horse/Level III**JR = Jr. Camp
T = TraditionalTH = Traditional Homeschool

**Requires equine director approval.

Custodial Parent/Legal Guardian Information

Relationship to Camper:

First Name:

Last Name:

Home Phone:

Work/Cell Phone:

Home Church:

Home Church City:

Emergency Contact Information

In case of emergency and parent cannot be reached, please notify the following person.

First Name:

Last Name:

Home Phone:

Work/Cell Phone:

Alternate Pick Up Information

If parent is unable to pick-up child, the following person has permission to pick-up the child.

First Name:

Last Name:

Camp Jabez, Ministry of the Gospel Mission, Inc., Dayton, Ohio
3191 State Route 380 Xenia, Ohio 45385
937.223.4513