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Wilderness Adventure

June 16 - 27, 2008  

INFORMATION  REQUEST  FORM


Please send me a Wilderness Adventure registration packet for:

 

Child's                                                                          Age/Grade
Name _____________________________________  as of 6/08 ___________

 

Child's                                                                          Age/Grade
Name _____________________________________  as of 6/08 ___________

 

Parent/Guardian Name: ____________________________________________

 

Mailing Address:  ________________________________________________  

 

Phone # ________________ E-mail _________________________________

Print this page, fill out the form and send to:

Wilderness Adventure Camp
c/o First Southern Baptist Church
89 Kimble Hill Road
Williamsport, PA 17701-8407