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
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: *
T-Shirt Size: *XSSMLXLXXL

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)

Name (first & last):
Date of Birth:
Email:
Street Address:
Cell Phone:
Work Phone:
Home Phone:
Relationship to camper: MotherFatherGuardianOther