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Removing Barriers and Building Bridges

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Living Waters Family Camp On-Line Registration

Attention:
There will be a limited number of full and partial scholarships available through Wiconi International. If you are requesting a scholarship we ask that you check the box and fill in ONLY the "Contact Information" area of the form, we will contact you privately for further information.
Please Note: Scholarships will not be available for "Deluxe or Pinewood" accommodations.
NOTE: If you request a scholarship it is not a guarantee that you will receive one. We will be accepting applications until June 15th, and scholarships will be awarded by July 1st.

On-Line Registration is payable via Credit Card Only, if you wish to pay by some other means please hit the back button†to download the PDF form listed on the last page.

We require a $125 deposit per family unit, for single adults the deposit is $75 required with (at the time of) registration. Your registration form, deposit, and all accommodation fees must be in our office NO LATER THAN JULY 10th. After July 10th, your deposit is non-refundable.

For more information, or questions†about family camp you can contact us via:
Email:
familycampinfo13@gmail.com

Please fill out the form below for on-line registration.

*Star Denotes Required*

Scholarship
I am applying for a scholarship



Contact Information  
* Last/Family Name:
* First Name:
Middle Initial:
Spouse First Name (If Applicable)
* Mailing Address:
* City:
* State/Province:
* Zip/Postal Code:
Country:
* Home Phone:
Work Phone:
Cell Phone:
E-Mail Address:
Tribal Affiliation (If Applicable)

Number Attending  
* How Many Adults:
How Many Children Ages 3 -11:
Please tell us the ages of your children (no names) to help us plan their activities according to age groups:
How Many Children Ages 12 - 15:
   
   

Housing Preference
 

NOTE: Accommodations are not guaranteed.
Availability is on a first-come/first-serve basis

We will do our best to provide you with the certain type of lodging you request,
however it is not guaranteed.

Choose Preference:







Chk box below if paying online using our secure website.

after clicking the submit button you will be forwarded to the thank you page.
On that page you will see a link to the secure website.
Click on that link to continue to secure area:

 


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Howard Lane of Agape Lane Ministry

Wiconi, a member of the Indigenous Pathways (IP) family of ministries