| Church Name | Hamilton Baptist |
| Church Street Address | 16 E Colonial Hwy |
| City | Hamilton |
| State/Province | VA |
| Zip/Postal Code | 20158 |
| Notes regarding the church address provided | |
| Chairman FIRST Name | John |
| Chairman LAST Name | Bocek |
| Chairman Street Address | 39556 Charles Town Pike |
| City | Hamilton |
| State/Province | VA |
| Zip/Postal Code | 20158 |
| Notes regarding the chairman info provided | |
| We'll be running these programs | Stockade |
| Total # boys anticipated to participate | 20 |
| We Agree to the responsibilities included in the Working Agreement | 1 |
| Region | Capital |