Parent InformationName(Required) First Last Email(Required) Relationship(Required)MotherFatherStepmotherStepfatherGrandparentGuardianCell Phone(Required)Work Phone(Required)Home AddressAddress(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone(Required)Camper InformationName(Required) First Last Gender(Required)MaleFemaleDate of Birth(Required)MMMM123456789101112DDDD12345678910111213141516171819202122232425262728293031YYYYYYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade Entering, Fall 2024(Required)School(Required)Does Camper speak English fluently?(Required)YesNoAny additional information about your camper you would like us to know? Allergies or Medical Conditions?Camp Registration OptionsDatesJune 16 – June 20June 23 – June 27July 07 – July 11Sessions to Join(Required)MorningAfternoonFull DayTotal Credit CardCard Details Cardholder Name
