Sequanota Lutheran Camp and Conference Center

Summer Camp

Summer Camp Registration Form

All the spaces with * are required

Parent Information

* Parent/Guardian Name:

* Address:

Address Continued:

* City: * State: * Zip:

* Home Phone: Work Phone:

E-Mail:

Camper Information

* Camper Name:

* Camp Name, Date:

* Gender: * Grade Completed in 2010

Cabin Buddy:

Church Name, Town:

Camp Choice:

Add-On Activity:

Please select if you would like to pay the deposit or the total cost of camp.

Pay $75.00 deposit

Pay Total Camp Cost

This is the total amount you will be charged

P.O. Box 245, Jennerstown, PA 15547 | Phone: (814) 629-6627