NE Bible Camp 2010 Online Registration Form Completely fill out this form before you click the "SUBMIT" button below. (once you Submit you cannot change or retrieve the information) To move between fields: Use "TAB" NOT "Enter". (using "Enter" on some browsers is the same as clicking "SUBMIT")
Head of House, Parent or Guardian who is filling out this form. (please also repeat your name and other information below if you are attending camp)
First Name		Last Name				Phone Number #1	Phone Number #2
Address					Email address
City		State	Zip		Home Church
		-- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
FIRST PERSON in Family attending camp
First Name		Last Name			Male  - Female		Housing Special Instructions:
							Share cabin with what family?
Date of Birth			Age		Grade next year
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84858687888990919293949596979899100		Not in SchoolKinder.1st2nd3rd4th5th6th7th8th9th10th11th12thCollege FreshmanCollege SophmoreCollege JuniorCollege Senior		Other housing, explanation:
Home Church				Christian
				--NoYes			If you have a medical need for electricity or indoor plumbing please explain it here:
Tshirt size: none Tshirt quantity 0
First choice for housing for this person
FIRST CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
Second choice for housing for this person
SECOND CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
SECOND PERSON in Family attending camp
First Name		Last Name			Male  - Female		Housing Special Instructions:
							Share cabin with what family?
Date of Birth			Age		Grade next year
JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC	01020304050607080910111213141516171819202122232425262728293031	1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008 2009 2010	0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100		Not in SchoolKinder.1st2nd3rd4th5th6th7th8th9th10th11th12thCollege FreshmanCollege SophmoreCollege JuniorCollege Senior		Other housing, explanation:
Home Church				Christian
				--NoYes			If you have a medical need for electricity or indoor plumbing please explain it here:
Tshirt size: none Tshirt quantity 0
First choice for housing for this person
FIRST CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
Second choice for housing for this person
SECOND CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
THIRD PERSON in Family attending camp
First Name		Last Name			Male  - Female		Housing Special Instructions:
							Share cabin with what family?
Date of Birth			Age		Grade next year
JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC	01020304050607080910111213141516171819202122232425262728293031	19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 2010	0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100		Not in SchoolKinder.1st2nd3rd4th5th6th7th8th9th10th11th12thCollege FreshmanCollege SophmoreCollege JuniorCollege Senior		Other housing, explanation:
Home Church				Christian
				--NoYes			If you have a medical need for electricity or indoor plumbing please explain it here:
Tshirt size: none Tshirt quantity 0
First choice for housing for this person
FIRST CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
Second choice for housing for this person
SECOND CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
FOURTH PERSON in Family attending camp
First Name		Last Name			Male  - Female		Housing Special Instructions:
							Share cabin with what family?
Date of Birth			Age		Grade next year
JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC	01020304050607080910111213141516171819202122232425262728293031	19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 2010	0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100		Not in SchoolKinder.1st2nd3rd4th5th6th7th8th9th10th11th12thCollege FreshmanCollege SophmoreCollege JuniorCollege Senior		Other housing, explanation:
Home Church				Christian
				--NoYes			If you have a medical need for electricity or indoor plumbing please explain it here:
Tshirt size: none Tshirt quantity 0
First choice for housing for this person
FIRST CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
Second choice for housing for this person
SECOND CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
FIFTH PERSON in Family attending camp
First Name		Last Name			Male  - Female		Housing Special Instructions:
							Share cabin with what family?
Date of Birth			Age		Grade next year
JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC	01020304050607080910111213141516171819202122232425262728293031	19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 2010	0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100		Not in SchoolKinder.1st2nd3rd4th5th6th7th8th9th10th11th12thCollege FreshmanCollege SophmoreCollege JuniorCollege Senior		Other housing, explanation:
Home Church				Christian
				--NoYes			If you have a medical need for electricity or indoor plumbing please explain it here:
Tshirt size: none Tshirt quantity 0
First choice for housing for this person
FIRST CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
Second choice for housing for this person
SECOND CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
SIXTH PERSON in Family attending camp
First Name		Last Name			Male  - Female		Housing Special Instructions:
							Share cabin with what family?
Date of Birth			Age		Grade next year
JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC	01020304050607080910111213141516171819202122232425262728293031	19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 2010	0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100		Not in SchoolKinder.1st2nd3rd4th5th6th7th8th9th10th11th12thCollege FreshmanCollege SophmoreCollege JuniorCollege Senior		Other housing, explanation:
Home Church				Christian
				--NoYes			If you have a medical need for electricity or indoor plumbing please explain it here:
Tshirt size: none Tshirt quantity 0
First choice for housing for this person
FIRST CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
Second choice for housing for this person
SECOND CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
SEVENTH PERSON in Family attending camp
First Name		Last Name			Male  - Female		Housing Special Instructions:
							Share cabin with what family?
Date of Birth			Age		Grade next year
JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC	01020304050607080910111213141516171819202122232425262728293031	19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 2010	0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100		Not in SchoolKinder.1st2nd3rd4th5th6th7th8th9th10th11th12thCollege FreshmanCollege SophmoreCollege JuniorCollege Senior		Other housing, explanation:
Home Church				Christian
				--NoYes			If you have a medical need for electricity or indoor plumbing please explain it here:
Tshirt size: none Tshirt quantity 0
First choice for housing for this person
FIRST CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
Second choice for housing for this person
SECOND CHOICE FOR HOUSING FOR THIS PERSONa. CABIN COUNSELOR:--------- (I will submit application)b. FAMILY TENT: ------------------ $50 discount- No youth without parentsc. FAMILY TRAILER: -------------- No discount. Hookups available.d. HOTEL: ------------------------------- I will make my own arrangementse. BOYS' CABIN: --------------------- Ages 8-17. No electricityf. GIRLS' CABIN: --------------------- Ages 8-17. No electricityg. MENS' CABIN: -------------------- Ages 18 and up. No electricityh. WOMENS' CABIN: -------------- Ages 18 and up. No electricityi. SHARE CABIN WITH OTHER FAMILY: -- $25 discount- give name on right of formj. PRIVATE ROOM FOR FAMILY: --------------- very few availablek. OTHER: -------------------------------------------------- Explain on the right side of this form
Registration Fee Calculation IMPORTANT NOTE: In the following sections, calculations are NOT performed automatically.  Please fill in ALL blanks that apply.
	Age	# people				Early Registration	Subtotal
(15)	Under 3					Free	$0.00
(16)	3-7					X $65.00	+
(17)	8-11					X $100.00	+
(18)	12 up					X $125.00	+
(19)	Total Registration						=
Amount Owed
(20)	Total Registration Fee from above ($375 max)						+
(21)	Number of T-shirts			x $9.00 per shirt			+
Note: If you are staying in a Hotel, you pay only for meals:
	Number of Meals			x $5.00 per meal			+
(22)	Donation for Needy Fund						+
(23)	Subtotal Amount Owed						=
Discounts
(24)	Tent Discount ($50)						-
(25)	Cabin Sharing Discount ($25)						-
(26)	Amount Requested from Needy Fund						-
(27)
(28)	Subtotal Discounts						=
Summary
(29)	Amount Owed minus Discounts   (23) - (28) =						=
(30)	$25 minimum Deposit to be mailed to:						-
			Northboro Church of Christ
			c/o Camp Registration
			Box 633
			Northboro, MA 01532-0633
(31)	Balance Due upon arrival at camp						=
MAKE SURE YOU SCROLL DOWN AND "SUBMIT" THIS FORM (WE WILL NOT RECEIVE ANY INFORMATION UNTIL YOU CLICK ON "SUBMIT")
Please write any comments here including any special needs you have for camp.
Write your comments here
Medical Forms and Application forms for Volunteers will be required. We will inform you when the forms are available. When you are finished, make sure all the information is correct and click on "Submit". (you cannot review information after you submit) Click on "Clear" if you need to start over.