Register for 2012

Camp 2012 Registration

Please complete the following registration form. You will need to submit a signed verification form and your payment in order to complete your camp registration.

1 General Information

2 Camper Information

3 Medical and Additional Information

Parent/Guardian Name (1)*
FirstLast
Parent/Guardian Email Address (1)*
Parent/Guardian (1) Cell Phone during Camp
Parent/Guardian Name (2)
FirstLast
Parent/Guardian Email Address (2)
Parent/Guardian (2) Cell Phone during Camp
Permanent Address*
Street AddressCityState / Province / RegionZip / Postal CodeCountry
Permanent Home Phone*
Local Address during Camp
Street AddressCityZip / Postal CodeCountry
Please list ONLY if different from your Permanent Address
Local Home Phone
Please list ONLY if different from your Permanent Home Phone
We are registering our child(ren) for the following week(s) of camp:
- Week One (July 1-6, 2012)
- Week Two (July 8-13, 2012)
- Week Three (July 15-20, 2012)
- Week Four (July 22-27, 2012)

Medical Information and Additional Information
Additional information regarding our child(ren)
Please list any medical condition, allergies, or other information regarding your child/ren. If you are registering more than one child for camp, please specify the child.
We would like to order an additional shirt for each child:*
- Yes
- No
Please add $12 per shirt to your camp payment

Camp 2012 Registration

Camper One

Camper Two

Camper Three

Camper Four

Medical Information and Additional Information