CAMP CRUX Servant Leader Staff

I'm committing to be a counselor for: REQUIRED CAMP CRUX (middle school girls: June 21-24, 2021) CAMP CRUX (middle school boys: July 12-15, 2021) Please fill out this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Birthday REQUIRED

MM/DD/YYYY

Please fill out this field. Please enter a date.

High School Please enter valid data.

College Year (2021-2022) Freshman Sophomore Junior Senior

College Please enter valid data.

In case of an emergency, please contact REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone REQUIRED Please fill out this field. Please enter valid data.

Home Parish Please enter valid data.

Do you play a musical instrument? Yes No

If so, what instrument?

Would you be willing to share your musical talent at CAMP CRUX either for Mass or around the campfire? Yes No

Do you have any food allergies? Yes No

If yes, please specify any food allergies:

Are there any special concerns for our awareness? Yes No

If yes, please specify:


610 Lingle Ave. Lafayette IN 47901 (765) 742-0275	The ministries of our diocese and this website are made possible through the generosity of the Fruitful Harvest donors. Thank you!

CAMP CRUX Servant Leader Staff

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