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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
1 2021-04-30 13:49:5924.160.118.196
Goldie Adkins
Mother
1
Pleasant Grove Road Church of Christ
Goldie Adkins
04/30/2021
Pay Upon Arrival with Cash or Check
2 2021-04-30 02:59:5175.115.238.193
Todd Monahan
Father
1
Pinellas Park coc
Todd monahan
04/29/2021
Pay Online Now
1 Camper : USD 35
3 2021-04-30 00:42:4573.91.50.84
Togbah Lamadine
Father
1
Sebring Parkway Church of Christ
Kuwoe Lamadine
04/29/2021
Pay Upon Arrival with Cash or Check
4 2021-04-29 01:37:1471.208.112.147
Sarah Ramer
Mother
1
Sebring Parkway Church of Christ
Nathan Albert Ramer
04/28/2021
Pay Upon Arrival with Cash or Check
5 2021-04-27 20:04:0865.35.187.250
Tameka Graham
Mother
1
Jaz'Myn S. Brown
04/27/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              6              				2021-04-26 20:18:4067.34.246.59
Kimberly Buckner
Mother
1
Pleasant Grove Rd CoC
Kimberly Buckner
04/26/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              7              				2021-04-24 17:46:38172.58.152.107
Karen Williams
Mother
1
Karen Williams
04/24/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              8              				2021-04-20 15:18:1497.96.71.78
SHENIA BROWNLOW DINDY
Mother
1
EAGLE LAKE COC
SHENIA BROWNLOW-DINDY
04/20/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              9              				2021-04-19 15:46:3673.27.77.99
Wayne Shearer
Grandparent
1
South Florida Avenue church of Christ
Wayne Shearer
04/18/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              10              				2021-04-18 21:27:23174.58.41.58
Sophia Coleman
Mother
1
Avon Park Church of Christ
Sophia  Coleman
04/18/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              11              				2021-04-18 20:27:3647.199.45.122
Rhonda Care
Mother
2
Grace Baptist church of north Tampa bay
Rhonda care
04/18/2021
Select
		                                                                                                               
                        
              12              				2021-04-17 23:48:56174.250.240.233
Anna Maldonado
Mother
3
Avon Park Church of Christ, Avon Park, FL
Anna Maldonado
04/17/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              13              				2021-04-17 18:12:5347.199.45.122
Rhonda Care
Mother
2
Grace Baptist church of north Tampa bay
Rhonda care
04/17/2021
Select
		                                                                                                               
                        
              14              				2021-04-17 17:32:0168.200.176.220
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
		                                                                                                               
                        
              15              				2021-04-16 20:57:4172.184.89.138
Beth Monroe
Mother
1
Orange Street Church of Christ
Beth Monroe
04/16/21
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              16              				2021-04-16 20:33:4965.33.166.137
Regina Greene
Mother
1
Midway church of Christ
Regina GREENE-Pinckert
04/16/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              17              				2021-04-16 17:57:4865.33.166.137
Regina Greenr Pinckert
Mother
1
Midway church of Christ
Regina GREENE-Pinckert
04/16/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              18              				2021-04-16 16:43:4624.236.82.253
Mattie Simmons
Grandparent
1
Central Church of Christ
Demetria Akins
04/16/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              19              				2021-04-15 18:19:13174.228.5.16
Wendy Deemer
Mother
2
Orange Street church of Christ
Wendy Deemer
04/15/2021
Pay Online Now
2 Campers : USD 70
		                                                                                                               
                        
              20              				2021-04-15 16:39:01174.228.133.27
Trudi Chambers
Mother
1
Orange street
Trudi chambers
04/14/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              21              				2021-04-14 19:26:1973.27.77.99
Anita Shearer
Grandparent
1
SFA church of Christ
Anita Shearer
04/14/2021
Select
		                                                                                                               
                        
              22              				2021-04-14 16:50:0772.187.45.106
Lisa Thomas
Mother
1
Orange Street
Lisa Thomas
04/14/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              23              				2021-04-14 15:32:5897.76.206.98
Cieara Edwards
Mother
1
SFA Church of Christ
Cieara Edwards
04/14/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              24              				2021-04-14 15:27:3097.76.206.98
Cieara Edwards
Mother
1
SFA Church of Christ
Cieara Edwards
04/14/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              25              				2021-04-14 13:25:3170.126.108.221
Christine Murray
Mother
1
Spring Hill church of Christ
CHRISTINE MURRAY
04/14/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              26              				2021-04-11 03:38:1847.201.169.34
Phillip Martin
Father
1
Pinellas Park Church of Christ
Phillip Martin
04/10/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              27              				2021-04-11 02:30:1365.35.105.252
Brian Kenyon
Step-Father
1
South Florida Avenue church of Christ
Brian R. Kenyon
04/10/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              28              				2021-04-11 01:58:5898.219.113.171
Kristi Tolbert
Mother
1
Port Charlotte church of Christ
Kristi Tolbert
04/10/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              29              				2021-04-08 18:25:0424.160.118.196
Goldie Adkins
Mother
2
Pleasant grove road church of Christ
Goldie adkins
04/08/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              30              				2021-04-07 17:58:42173.169.113.229
Sabrina Tagtow
Mother
3
Orange ST
sabrina tagtow
4/7/21
Pay Online Now
3 Campers : USD 105
		                                                                                                               
                        
              31              				2021-04-07 17:24:4324.73.39.129
Lauren Bynum
Mother
1
Orange Street Church of Christ
Lauren Bynum
04/07/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                        
              32              				2021-04-07 16:49:27174.250.241.202
Dennis Chalaire
Father
1
Port Charlotte Church of Christ
Dennis Chalaire
04/07/2021
Pay Upon Arrival with Cash or Check
		                                                                                                               
                        
              33              				2021-04-06 23:41:41143.59.83.8
Test McTester
Father
1
NWCOC
Signature
04/06/2021
Pay Online Now
1 Camper : USD 35
		                                                                                                               
                    
      
          
        


																	


								

																	

								
															


						
			

		

		
	





	

		

					
				
		

	


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