Day Camp Director: Bill Coffin July 9-11 – 9am-2pm Online Camp Application*Day Camp: July 8 - 10Name* First Last Phone*Grade*Kindergaten1st Grade2nd Grade3rd GradeSex*MaleFemaleAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Parent/Guardian* Parent Is Serving As Counselor Yes No Counselor's ChildCounselor's ChildAs a counselor serving at camp the registration for your child is half off.Church Attending Allergies, Medications, or Medical Concerns*Insurance Company* Policy #* I have read the 2024 QMCC camper application and agree to follow the policies outlined in this publication and abide by the decisions made by camp directors and/or manager. I understand that cell phones and car keys are to be secured and not used during the camp session without camp director/manager knowledge and approval. I understand we feel very strongly that we need to be modest and be a shining light to the world. No tank-tops, shorts/skirts need to be past mid-thigh. No low cut blouses or t-shirt. No clothing with inappropriate printing, and no saggy pants or shorts (no shown underwear). Although QMCC takes measures to assure a safe environment, it assumes no responsibility for personal property brought to camp or liability of such items that may be brought to camp. It is understood that campers should leave valuables at home and cell phones will be secured and given back at the end of the week. QMCC will take all reasonable and appropriate safety measures but assumes no responsibility for each persons health. QMCC has my permission to seek appropriate medical action as needed. I also agree that any photos taken of my child while at camp may be used for QMCC promotion. My child and I agree to these policies. Terms & Conditions* I Agree To Follow Camp Policies Pay By Check Option Pay Upon Arrival If you select this option you agree to pay the amount in full upon arrival to QMCC.QMCC Camp T-Shirt SizeNoneYouth SmallYouth MediumYouth LargeSmallMediumLargeX-LargeXX-LargeXXX-LargeQMCC Camp T-Shirt Size (Pay Upon Arrival)*NoneYouth Small ($12)Youth Medium ($12)Youth Large ($12)Small ($12)Medium ($12)Large ($12)X-Large ($12)XX-Large ($12)XXX-Large ($13)Total $0.00