2014 TN Middle School Leadership Camp

D.O.B. _____ / _____ / _____
JU
LY
3
0
RU
TH
E3
Jackson: David Hicks 731-234-4165
Johnson City: Steve McAuley 423-306-4889
Kingsport: Marsha Barnes 423-765-7316
Knoxville: Dean Craig 865-524-6076
Lakeway: Scott Galyon 865-712-6619
Memphis: Larry Coley 901-683-3399
Murfreesboro: Brian Harrell 615-426-1995
Nashville: Mark Wracher 615-889-8808
NW TN: Barry Duncan 731-446-1710
AGE: _______
PHONE: ( _____ ) _____ - _______
CITY: _____________________ STATE: ____ ZIP: ________
ADDRESS: _______________________________________
JU
N
EMAIL: _________________________________________
WORK PHONE: ( _____ ) _____ - _______
CELL PHONE: ( _____ ) _____ - _______
HOME PHONE: ( _____ ) _____ - _______
NAME: _________________________________________
SCHOOL (NO ABBREV.): ______________________________
GRADE IN FALL: ________
GENDER: MALE / FEMALE
CAMPER NAME: __________________________________
CAMPER INFORMATION
REGISTRATION FORM (SIDE 1 OF 2)
P
M
CA
L
Hendersonville: Jason McCormick 615-217-7700
IP
Greeneville: Larry Bible 423-329-7320
SH
OO
Clarksville: Gary Rankhorn 931-503-3284
ER
CH
CONTACT YOUR LOCAL FCA TO REGISTER!
Chattanooga: Jay Fowler 423-877-3561
AD
FOR MORE DETAILS PLEASE CONTACT
CAMP DIRECTOR BEN GOOCH:
(931)477-0306, [email protected]
LE
Rooming is dorm-style and all meals during
camp will be provided.
FELLOWSHIP OF
CHRISTIAN ATHLETES
S
LE
CHOOSE: MR. / MRS. / MS.
PACKING LIST
Bedding (pillow, twin-size sheets, sleeping bag)
Towels & Toiletries
Athletic Shoes, Extra Clothes & Swim Suit (1-piece)
DD
CHOOSE: PARENT / GUARDIAN
FCA MIDDLE SCHOOL LEADERSHIP
CAMP IS OPEN FOR STUDENTS
ENTERING 6TH GRADE THROUGH
ENTERING 9TH GRADE
MI
PARENT/GUARDIAN INFORMATION
CAMP DETAILS
Ocoee Region: Robert Green 423-284-0105
Smoky Mtn Area: Steve Llewellyn 615-785-2018
SW Middle TN: Ben Gooch 931-477-0306
Upper Cumberland: Noel Cherry 931-372-2123
COVENANT COLLEGE
14049 SCENIC HIGHWAY
LOOKOUT MOUNTAIN, GA 30750
REGISTRATION FORM (SIDE 2 OF 2)
REGISTRAIONT DETAILS
PLEASE TURN IN REGISTRATION FORM
AND PAYMENT TO YOUR LOCAL FCA
OFFICE. CONTACT INFORMATION FOR
EACH OFFICE IS LOCATED ON THE BACK
OF THIS BROCHURE.
It is an overnight camp at Covenant College
for students entering the 6th-9th grades.
Campers will learn leadership skills to help
lead FCA at their schools. Of course
everything will be done in awesome FCA
style including: sports competitions, crazy
games, new friendships, and great worship.
Can’t wait to see you there!
IF YOU NEED A SCHOLARSHIP,
CONTACT YOUR LOCAL FCA OFFICE
TO SEE IF ANY ARE AVAILABLE.
PAYMENT INFORMATION
AMOUNT INCLOSED ($100 DOWN-PAYMENT REQUIRED: _______________
Discover / VISA / MasterCard / Am.Expr.
FCA SCHOLARSHIP AMOUNT: _______________
□ CASH □ CHECK
□ CARD (CIRCLE CARD TYPE):
CARD #: ____________________________________ EXP DATE: ___ / ______
CARD HOLDER NAME: _____________________________________________
BILLING ADDRESS: ________________________________________________
Camp Pastor
UTC Wrestling Head Coach
HEATH ESLINGER
PLEASE LIST ANY SPECIAL DIETARY
NEEDS OR FOOD ALLERGIES
WHAT IS THE COST FOR
FCA CAMP?
PARENT/GUARDIAN SIGNATURE: ____________________________________
Worship Leader
Atlanta, GA
We will try our best to accommodate!
Camp Pastor
Bridge Fellowship: Mt. Juliet
PHIL WILSON
● FCA “ALL IN” T-SHIRT
● FCA “ALL IN” LANYARD
● 2014 FCA BIBLE
● NEW FRIENDS
● GREAT MEMORIES
JAKE GULLEDGE
WHAT DO YOU GET AT FCA
MIDDLE SCHOOL CAMP?
$230
WHAT IS MIDDLE SCHOOL
LEADERSHIP CAMP?