Peace Camp 2023 Registration

Parent/Guardian Name(s) *

first and last name

Address *

Address

City

State/Province

Zip/Postal

Phone *

Email *

Number of Campers Registering *

First and Last Name of Camper 1 *

first and last name

Age of Camper 1 on 6/5/23 *

Birthdate

First and Last Name of Camper 2 *

first and last name

Age of Camper 2 on 6/5/23 *

Birthdate

First and Last Name of Camper 3 *

first and last name

Age of Camper 3 on 6/5/23 *

Birthdate

My camper(s) will ride the van.

Yes

No

They will ride from:

Great Bend

Larned

“Oneness with Earth Heals.”