Mount Hermon

Summer Camp

HSM dates - June 25 - July 1

To sign up,

Step 1. Please complete the form - one for each student you are registering.

Step 2. Complete one payment for all student’s you are signing up. Online payment is available at the bottom of this page, or you can mail a check to us at

Creekside Community Church
1350 Danville Blvd, Alamo, CA 94507

Student Name

First Name

Last Name

Student Age

Gender

Male

Female

Registering Parent / Guardian's Name

First Name

Last Name

Parent's Email Address

Address

Which Camp Are You Interested In?

Medical Insurance Company

Policy Number

Emergency Contact

First Name

Last Name

Contact #

(###)

###

####

Please List Any Allergies

if applicable.

Are There Any Conditions That Might Hinder Your Student From Participating In Activies?

Parent / Guardian Signature

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Mount Herman Summer Camp 2023

$755.00

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