The Pentecostals of Mandeville

POM Bible Boot Camp

STIM Registration Form

Parents/Guardians can register their child
as a STIM Volunteer (ages 12-17) using the form below (1 form/STIM).
Campers (ages 4-11) & Adult (ages 18 & up) Volunteer registration forms
must be completed separately.

Please complete parent/guardian contact information first, then the information for STIM/Student.
(This form must be completed by a parent or guardian.)

Registration deadline to ensure T-shirt: Wednesday, June 22nd.
T-shirt Fee ($12/shirt) can be paid on the POM App Giving portal, or by check or cash to The POM.

Parent/Guardian Contact

First Name

Last Name

Email Address

Cell Phone

Spouse/Secondary Contact First Name

Spouse/Secondary Contact Last Name

Cell Phone

Address 1

Address 2

Country

City

State

Zip/Postal Code

STIM Volunteer Information

First Name

Last Name

Gender
Male
Female

Email Address:

Cell Phone Number:

DOB

Age as of July 1, 2022

STIM T-shirt Size (STIM must wear BBC T-shirt each night - T-shirt fee is $12.00)

STIM Agreement

By signing below, I agree to submit myself to the BBC Director and those leading this camp and perform the job they assign to me. I will be on time and prepared each night. I will comply with the following modesty dress code: No shorts, leggings, or bare shoulders. Skirts/dresses must be to the knee.
I Agree

Student/STIM Signature (type your name below to sign):

Parent/Guardian Authorization & Release

The Pentecostals of Mandeville reserves the right to use, broadcast and/or publish any photos and/or videos taken during Bible Boot Camp. I further release The Pentecostals of Mandeville and its leaders & volunteers from any claim that my child may have against them as a result of an injury or illness incurred during the course of participation in the activities. In the event of an emergency, I give permission to transport my child to a hospital for emergency treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
I Agree

I agree to pay my T-shirt fee of $12/shirt by Wednesday, June 22nd to The POM app, or by cash or check to the POM.
I Agree

Parent/Guardian Signature (type your name below to sign):

SUBMIT