SPFC Registration

'11 SPFC 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 (burke@gcrcc.org  cathy@gcrcc.org)

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 (must be 4 years old) through teens who
have graduated HS in 2011.

First name                                                  Last Name                                                       
M / F (circle)      Age           
Grade Entering (fall 2011)                 Check here if child will graduate HS '11 _____     

T-shirt size: _____

First name                                                  Last Name                                                       
M / F (circle)      Age           
Grade Entering (fall 2011)                 Check here if child will graduate HS '11 _____     

T-shirt size: _____

First name                                                  Last Name                                                       
M / F (circle)      Age           
Grade Entering (fall 2011)                 Check here is child will graduate HS '11 _____     

T-shirt size: _____

First name                                                  Last Name                                                       
M / F (circle)      Age           
Grade Entering (fall 2011)                 Check here if child will graduate HS '11 _____     

T-shirt size: _____

First name                                                  Last Name                                                       
M / F (circle)      Age           
Grade Entering (fall 2011)                 Check here if child will graduate HS '11 _____     

T-shirt size: _____