Camp Kekoka Registration

YMCA Camp Kekoka Resident Camp Registration
What name does your camper prefer to be called? Nickname?
Camper's Address
Street Address
Street Address 2 - Apartment #, Box, Suite#
City
State/Province
Zip/Postal
Birthday Card Address
City
State/Province
Zip/Postal
Name of school currently attending.
Enter the grade camper will be in next school year.
Cottages are assigned by age/grade level and requests must be mutual.

PARENT/GUARDIAN #1 INFORMATION

Please complete the information below on the parent/guardian for the camper.
Parent/Guardian #1 Address
Street Address
Street Address 2 - Apartment #, Box, Suite#
City
State/Province
Zip/Postal

PARENT/GUARDIAN #2 INFORMATION

Please complete the information below on the parent/guardian for the camper.
Parent/Guardian #2 Address
City
State/Province
Zip/Postal

EMERGENCY CONTACT INFORMATION

Please complete the information below for emergency contact person for your camper.
Do You Have a Question?

Our mission is to put Christian principles into practice through programs that build healthy spirit, mind and body for all.