Registration Form | Prairie Lakes Distri

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Prairie Lakes District Assembly & Family Camp

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Making Tea in Nature

Family Camp and
District Assembly Registration

First Name

Last Name

Street Address

City

Region/State/Province

Postal / Zip code

Email

Phone

# of adults

# of children 0-3 yrs

# of children 4 yrs through 1st grade

# of children 2nd through 6th grade

# of children 7th through 12th grade

If you have any special needs that should be considered for lodging please descirbe that here

If you are registering for someone else named above, please put your name and phone number here

If you're connected to a local church on the Prairie Lakes District, please list it here

Volunteers: please indicate your role

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