Swamp Camp Mission Alliance Inc. Online Registration

Registration

Already a customer? Click here to login.

Welcome to Swamp Corps' Online Application Form.

If you have previously completed this form, click here to proceed to your Swamp Corps Account.

Be sure to pay required deposit to complete process/save spot.

Must be listed as a student in your family account to apply for a trip.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Account Information

Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (name, phone, relationship to camper)*

Insurance Co. Name, Address, Policy #, Group #, Phone*

Contact #1

Billing Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Swamp Camp Mission Alliance Inc.. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Participant Gender*

Birth Date*

Additional Info

Participant Email

T-Shirt Size*

Passport Info: (number, date of issue, date of expiry).

What treatment have you had for Psychiatric, Mental or Behavioral Disorders?*

Health History (see list in Policies tab or below in Registration Form)*

Other Special Needs

Allergies (medicines, foods, OTCs, etc.)*

Medications (name and dosage taken daily or when necessary)*

Primary Doctor/Phone*

Immunizations Up-to-date?*

Date of Last Tetanus Shot*

Hospitalized in last year?*

Church Name*

Class = Any Current Opening Offered

This is NOT a preference order...these are the trip dates you actually plan to attend.

For an additional person, click the Add Another Student button below.

PARENTS/GUARDIANS: please add yourself as a student to register for any trip. The contact information you entered above is only for creation of the account contact.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Participant Gender*

Birth Date*

Additional Info

Participant Email

T-Shirt Size*

Passport Info: (number, date of issue, date of expiry).

What treatment have you had for Psychiatric, Mental or Behavioral Disorders?*

Health History (see list in Policies tab or below in Registration Form)*

Other Special Needs

Allergies (medicines, foods, OTCs, etc.)*

Medications (name and dosage taken daily or when necessary)*

Primary Doctor/Phone*

Immunizations Up-to-date?*

Date of Last Tetanus Shot*

Hospitalized in last year?*

Church Name*

Class = Any Current Opening Offered

This is NOT a preference order...these are the trip dates you actually plan to attend.

For an additional person, click the Add Another Student button below.

PARENTS/GUARDIANS: please add yourself as a student to register for any trip. The contact information you entered above is only for creation of the account contact.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Participant Gender*

Birth Date*

Additional Info

Participant Email

T-Shirt Size*

Passport Info: (number, date of issue, date of expiry).

What treatment have you had for Psychiatric, Mental or Behavioral Disorders?*

Health History (see list in Policies tab or below in Registration Form)*

Other Special Needs

Allergies (medicines, foods, OTCs, etc.)*

Medications (name and dosage taken daily or when necessary)*

Primary Doctor/Phone*

Immunizations Up-to-date?*

Date of Last Tetanus Shot*

Hospitalized in last year?*

Church Name*

Class = Any Current Opening Offered

This is NOT a preference order...these are the trip dates you actually plan to attend.

For an additional person, click the Add Another Student button below.

PARENTS/GUARDIANS: please add yourself as a student to register for any trip. The contact information you entered above is only for creation of the account contact.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Participant Gender*

Birth Date*

Additional Info

Participant Email

T-Shirt Size*

Passport Info: (number, date of issue, date of expiry).

What treatment have you had for Psychiatric, Mental or Behavioral Disorders?*

Health History (see list in Policies tab or below in Registration Form)*

Other Special Needs

Allergies (medicines, foods, OTCs, etc.)*

Medications (name and dosage taken daily or when necessary)*

Primary Doctor/Phone*

Immunizations Up-to-date?*

Date of Last Tetanus Shot*

Hospitalized in last year?*

Church Name*

Class = Any Current Opening Offered

This is NOT a preference order...these are the trip dates you actually plan to attend.

For an additional person, click the Add Another Student button below.

PARENTS/GUARDIANS: please add yourself as a student to register for any trip. The contact information you entered above is only for creation of the account contact.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Participant Gender*

Birth Date*

Additional Info

Participant Email

T-Shirt Size*

Passport Info: (number, date of issue, date of expiry).

What treatment have you had for Psychiatric, Mental or Behavioral Disorders?*

Health History (see list in Policies tab or below in Registration Form)*

Other Special Needs

Allergies (medicines, foods, OTCs, etc.)*

Medications (name and dosage taken daily or when necessary)*

Primary Doctor/Phone*

Immunizations Up-to-date?*

Date of Last Tetanus Shot*

Hospitalized in last year?*

Church Name*

Class = Any Current Opening Offered

This is NOT a preference order...these are the trip dates you actually plan to attend.

For an additional person, click the Add Another Student button below.

PARENTS/GUARDIANS: please add yourself as a student to register for any trip. The contact information you entered above is only for creation of the account contact.

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

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Registration

Referral Information

Family Account Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Required Policies

(Show-Hide Details)