Clone of Camper Registration 2026

1
Youth Camp 2026

Unstoppable

VA Church of God - Hispanic Ministries

Date: August 5-8

Place: VA COG State Offices

8018 Angel Ln. Roanoke, VA 24019

Cost: $100

*2nd Household Member: $90

*3rd Household Member: $80

**Non-Refundable**
2
How many campers are you registering?* This field is required.
Please Select
Please Select
1
2
3
3
Camper 1* This field is required.
First Name
Middle Name
Last Name
4
Birth Date of Camper 1* This field is required.
Month
Day
Year
5
Sex of Camper 1* This field is required.
Please Select
Please Select
Female
Male
6
Camper #2* This field is required.
First Name
Middle Name
Last Name
7
Birth Date of Camper #2* This field is required.
Month
Day
Year
8
Sex of Camper #2* This field is required.
Please Select
Please Select
Female
Male
9
Camper #3* This field is required.
First Name
Middle Name
Last Name
10
Birth Date of Camper #3* This field is required.
Month
Day
Year
11
Sex of Camper #3* This field is required.
Please Select
Please Select
Female
Male
12
Camper #4* This field is required.
First Name
Middle Name
Last Name
13
Birth Date of Camper #4* This field is required.
Month
Day
Year
14
Sex of Camper #4* This field is required.
Please Select
Please Select
Female
Male
15
Phone Number* This field is required.
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Address* This field is required.
Street Address
Street Address Line 2
City
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Please Select
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Falkland Islands
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Fiji
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Other
Country
17
E-mail* This field is required.
example@example.com
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Church District* This field is required.
Norfolk
Alexandria
Richmond
Roanoke
19
Church Name* This field is required.
20
Pastor's Name* This field is required.
21
Youth Leader's Name* This field is required.
22
Youth Leader's Phone Number* This field is required.
23
Emergency Contact * This field is required.
Name
Relation
Phone number
24
Please note any allergies, medical conditions, or prescriptions camp leaders should be aware of:
25
CartA processing Fee will be added to the final cost, and household discount will be substracted at the end.
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My Bag
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My Bag
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$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Processing FeeUSD
SubtotalUSD
Total costUSD
Registration
$100.00Edit
Back
1
1
2
3
4
Quantity
Subtotal: $0.00
Family Discount (Same Household)
Second ticket
$90.00Edit
Back
1
1
Quantity
Family Discount (Same Household)
Third ticket
$80.00Edit
Back
1
1
Quantity
Shirts
$13.00Edit
Back
Size Quantity
S
1
2
3
4
5
6
7
8
9
10
M
1
2
3
4
5
6
7
8
9
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L
1
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5
6
7
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XL
1
2
3
4
5
6
7
8
9
10
XXL
1
2
3
4
5
6
7
8
9
10
Subtotal: $0.00
Enter Coupon
Total cost $0.00
Payment Methods
Credit Card
First Name
Last Name
Google Pay
After submitting the form, you will be redirected to the Google Pay to complete the payment process.
Apple Pay
After submitting the form, you will be redirected to the Apple Pay to complete the payment.
Should be Empty:

Size	Quantity
S	1 2 3 4 5 6 7 8 9 10
M	1 2 3 4 5 6 7 8 9 10
L	1 2 3 4 5 6 7 8 9 10
XL	1 2 3 4 5 6 7 8 9 10
XXL	1 2 3 4 5 6 7 8 9 10