Outdoor & Retreat Ministries - 262.245.6706 · info@niccamp.org
NIC Summer Camp Registration Form - 2019
Select One Camp: @ Reynoldswood: East Jordan   J.O.Y.   Youth Serve   Woodland   Chicago Metro
@ Wesley Woods: Family   Sailing 2   C.A.P.A.   WaterSports
Camper's Name: First:     Middle:     Last:
Nickname:
T-Shirt Size: Youth-Medium   Adult-Small   Adult-Medium   Adult-Large  
Adult-XL  Adult-XXL  Adult-XXXL 
Birthdate: Month:     Day:     Year:
Entering Fall Grade: 2   3   4   5   6   7   8   9   10   11   12   13  n/a - Adult
Gender: Male   Female  
Your Home Church:
Church Town:
Request Up to 2 Cabin-mates (CM) Below:
CM 1:           CM 2:

Parent / Guardian
Parent/Guardian
(for registration questions):
First:   Last:   Relation:
Phone 1: - -
Phone 2: - -
Text #: - -
e-Mail:
Mail Address: P.O. Box / Street:
City:     State:     Zip:

Debit / Credit Card Payments
Name on Card: First:         Last:
Card #:     Card Security Code:The CSC/CSV/CVV is NOT your PIN number. It is an extra ID printed on your card. It appears on the back of Visa, MasterCard and Discover (3 digits), and on the front of American Express (4 digits).
Expiration: Month:     Year:
Billing Address:
City:     State:     Zip:
Signature:     Amount to Charge: ($50 Minimum)
By my signature above, I am instructing Outdoor & Retreat Ministries to charge the amount indicated (in the "Amount to Charge" box to the right of my signature), to my above-specified debit/credit card. If I neglect to specify an amount, I understand that it will be charged the non-refundable $50 deposit.

Please complete the above form and mail it to the appropriate site:
Camp Reynoldswood
621 Reynoldswood Road
Dixon, IL 61021
  Wesley Woods Retreat Center
250 Stam Street
Williams Bay, WI 53191

If paying by check, make it payable to "NIC ORM" AND print your Camper's Last Name, First Name in the Memo Field.
 
Questions? Call 815-284-6979