May Retreat Applications and Payments

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#Submit DateSubmitter's IP AddressParent/Guardian NameRelationship to Camper(s)How many campers are applying at this time?Home CongregationCamper 3 - Check any physical conditions below which the camp director or nurse should know. Reporting such conditions will not prevent the child from attending camp and will be kept in confidence by the staff.Camper 3 - Any Known Allergies, What is the reaction and what treatment is necessary i.e. Epi Pen, Benadryl?Camper 3 - Any Current Medications, include frequency and dose detailsCamper 3 - This camper has my permission to attend camp and participate in all activities EXCEPT the following: (Check those activities in which the child should NOT participate in.)Electronic SignatureDateSelect Payment MethodNumber of CampersPayment Info
12021-04-30 09:49:5924.160.118.196
Goldie Adkins
Mother
1
Pleasant Grove Road Church of Christ
Goldie Adkins
04/30/2021
Pay Upon Arrival with Cash or Check
22021-04-29 22:59:5175.115.238.193
Todd Monahan
Father
1
Pinellas Park coc
Todd monahan
04/29/2021
Pay Online Now
1 Camper : USD 35
32021-04-29 20:42:4573.91.50.84
Togbah Lamadine
Father
1
Sebring Parkway Church of Christ
Kuwoe Lamadine
04/29/2021
Pay Upon Arrival with Cash or Check
42021-04-28 21:37:1471.208.112.147
Sarah Ramer
Mother
1
Sebring Parkway Church of Christ
Nathan Albert Ramer
04/28/2021
Pay Upon Arrival with Cash or Check
52021-04-27 16:04:0865.35.187.250
Tameka Graham
Mother
1
Jaz'Myn S. Brown
04/27/2021
Pay Upon Arrival with Cash or Check
62021-04-26 16:18:4067.34.246.59
Kimberly Buckner
Mother
1
Pleasant Grove Rd CoC
Kimberly Buckner
04/26/2021
Pay Upon Arrival with Cash or Check
72021-04-24 13:46:38172.58.152.107
Karen Williams
Mother
1
Karen Williams
04/24/2021
Pay Upon Arrival with Cash or Check
82021-04-20 11:18:1497.96.71.78
SHENIA BROWNLOW DINDY
Mother
1
EAGLE LAKE COC
SHENIA BROWNLOW-DINDY
04/20/2021
Pay Upon Arrival with Cash or Check
92021-04-19 11:46:3673.27.77.99
Wayne Shearer
Grandparent
1
South Florida Avenue church of Christ
Wayne Shearer
04/18/2021
Pay Upon Arrival with Cash or Check
102021-04-18 17:27:23174.58.41.58
Sophia Coleman
Mother
1
Avon Park Church of Christ
Sophia Coleman
04/18/2021
Pay Upon Arrival with Cash or Check
112021-04-18 16:27:3647.199.45.122
Rhonda Care
Mother
2
Grace Baptist church of north Tampa bay
Rhonda care
04/18/2021
Select
122021-04-17 19:48:56174.250.240.233
Anna Maldonado
Mother
3
Avon Park Church of Christ, Avon Park, FL
Anna Maldonado
04/17/2021
Pay Upon Arrival with Cash or Check
132021-04-17 14:12:5347.199.45.122
Rhonda Care
Mother
2
Grace Baptist church of north Tampa bay
Rhonda care
04/17/2021
Select
142021-04-17 13:32:0168.200.176.220
Shannon Willcut
Mother
3
South Florida Ave church of christ
Eggs, rash, benadryl
No
Shannon willcut
04/17/2021
Pay Online Now
3 Campers : USD 105
152021-04-16 16:57:4172.184.89.138
Beth Monroe
Mother
1
Orange Street Church of Christ
Beth Monroe
04/16/21
Pay Online Now
1 Camper : USD 35
162021-04-16 16:33:4965.33.166.137
Regina Greene
Mother
1
Midway church of Christ
Regina GREENE-Pinckert
04/16/2021
Pay Online Now
1 Camper : USD 35
172021-04-16 13:57:4865.33.166.137
Regina Greenr Pinckert
Mother
1
Midway church of Christ
Regina GREENE-Pinckert
04/16/2021
Pay Online Now
1 Camper : USD 35
182021-04-16 12:43:4624.236.82.253
Mattie Simmons
Grandparent
1
Central Church of Christ
Demetria Akins
04/16/2021
Pay Upon Arrival with Cash or Check
192021-04-15 14:19:13174.228.5.16
Wendy Deemer
Mother
2
Orange Street church of Christ
Wendy Deemer
04/15/2021
Pay Online Now
2 Campers : USD 70
202021-04-15 12:39:01174.228.133.27
Trudi Chambers
Mother
1
Orange street
Trudi chambers
04/14/2021
Pay Online Now
1 Camper : USD 35
212021-04-14 15:26:1973.27.77.99
Anita Shearer
Grandparent
1
SFA church of Christ
Anita Shearer
04/14/2021
Select
222021-04-14 12:50:0772.187.45.106
Lisa Thomas
Mother
1
Orange Street
Lisa Thomas
04/14/2021
Pay Online Now
1 Camper : USD 35
232021-04-14 11:32:5897.76.206.98
Cieara Edwards
Mother
1
SFA Church of Christ
Cieara Edwards
04/14/2021
Pay Upon Arrival with Cash or Check
242021-04-14 11:27:3097.76.206.98
Cieara Edwards
Mother
1
SFA Church of Christ
Cieara Edwards
04/14/2021
Pay Upon Arrival with Cash or Check
252021-04-14 09:25:3170.126.108.221
Christine Murray
Mother
1
Spring Hill church of Christ
CHRISTINE MURRAY
04/14/2021
Pay Upon Arrival with Cash or Check
262021-04-10 23:38:1847.201.169.34
Phillip Martin
Father
1
Pinellas Park Church of Christ
Phillip Martin
04/10/2021
Pay Online Now
1 Camper : USD 35
272021-04-10 22:30:1365.35.105.252
Brian Kenyon
Step-Father
1
South Florida Avenue church of Christ
Brian R. Kenyon
04/10/2021
Pay Online Now
1 Camper : USD 35
282021-04-10 21:58:5898.219.113.171
Kristi Tolbert
Mother
1
Port Charlotte church of Christ
Kristi Tolbert
04/10/2021
Pay Online Now
1 Camper : USD 35
292021-04-08 14:25:0424.160.118.196
Goldie Adkins
Mother
2
Pleasant grove road church of Christ
Goldie adkins
04/08/2021
Pay Upon Arrival with Cash or Check
302021-04-07 13:58:42173.169.113.229
Sabrina Tagtow
Mother
3
Orange ST
sabrina tagtow
4/7/21
Pay Online Now
3 Campers : USD 105
312021-04-07 13:24:4324.73.39.129
Lauren Bynum
Mother
1
Orange Street Church of Christ
Lauren Bynum
04/07/2021
Pay Online Now
1 Camper : USD 35
322021-04-07 12:49:27174.250.241.202
Dennis Chalaire
Father
1
Port Charlotte Church of Christ
Dennis Chalaire
04/07/2021
Pay Upon Arrival with Cash or Check
332021-04-06 19:41:41143.59.83.8
Test McTester
Father
1
NWCOC
Signature
04/06/2021
Pay Online Now
1 Camper : USD 35
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