Senior High Camp Registration 2025

Student Information

Student Name:

Student Gender:

Female Male

Student Age:

Student Birthday:

Please list any student allergies or medications:

Parent / Guardian Information

Parent Email:

This address will receive a confirmation email

Home Address:

Emergency Contact 1:

Phone - Emergency Contact 1:

Emergency Contact 2:

Phone - Emergency Contact 2:

Insurance

By filling out the information below, I give consent for the leaders of the GSM Youth Retreat to seek medical attention for my child, should the need arise.

Insurance:

Policy Number:

Payment

Payment:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form to sign your student up for GSM's 2025 Sr. High Camp!

Who: Incoming 9th - Outgoing 12th graders from GSM

When: Monday, July 7th - Friday, July 11th, 2025

Where: Sagmount Baptist Camp, Joplin, MO
The camp is about 5 hours from GBC.

Cost: $185

Senior High Camp Registration 2025

Description

Please Fix the Following