Registration Form

Please fill out form below. (* Required fields)

CAMPER INFORMATION

Name: *

Email Address: *

Gender: *

Phone: *

Address:*

Date of Birth: *

Your Age at the time of camp in June/July/August 2019: *

Grade entering in the Fall of 2019: *

Does the camper hold a current passport?: *YesNo

Please select which camp session you are interested in: *June 30, 2019 - July 13, 2019July 21, 2019 - August 03, 2019August 11, 2019 - August 24, 2019

Has the camper traveled outside the U.S? If yes, please list countries visited. *

List any allergies and/or dietary restrictions: *

List any medical and/or health conditions: *

PARENT/GUARDIAN INFORMATION #1

Name (first & last): *

Date of Birth: *

Email: *

Street Address: *

Cell Phone: *

Work Phone: *

Home Phone: *

Relationship to camper: *MotherFatherGuardianOther

PARENT/GUARDIAN INFORMATION #2

Name (first & last):

Date of Birth:

Email:

Street Address:

Cell Phone:

Work Phone:

Home Phone:

Relationship to camper: MotherFatherGuardianOther

Emergency Contacts (in addition to parents & guardians)