THE BEARDED DRAGON GAMES
Camper Name
Last Name
*
First Name
*
Middle Name
Gender
*
Male
Female
Other
Camper's Information
Address
*
City
*
State
*
Zip
*
Home Phone
*
-
Area Code
Phone Number
Emergency Contact Name(if parent or guardian is not available)
*
Emergency Number
*
-
Area Code
Phone Number
Emergency Number #2
-
Area Code
Phone Number
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Current School Grade
*
Please Select
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
Grade entering in the fall
*
Please Select
Sophomore
Freshmen
8th
7th
6th
5th
4th
3rd
2nd
Parent or Legal Guardian Information
Parent/Legal Guardian
*
Relation
*
Work Phone
*
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Parent /Legal Guardian 2
Relation 2
Work Phone 2
-
Area Code
Phone Number
Cell Phone 2
-
Area Code
Phone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)
Camper's Email
Health Information
Any activity the camper should be restricted from?
*
Any physical, mental or other condition that would require special attention or care while at camp?
*
List any allergies (ex: bees,peanuts, dairy)
*
Any dietary needs that we should know about?
*
Payment Information
$50 deposit due at time of registration. Payment is due in FULL at the beginning of camp. Register before May 1st to receive entry into any week for only $250!
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50.00
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Type a question
*
Week #1 (July 6th-10th) • $300
Week #2 (July 13th-17th) • $300
Week #3 (July 20th-24th) • $300
Week #4 (July 27th-31st) • $300
Week #5 (August 3rd-7th) • $300
Any 3 Weeks • $800
All 5 Weeks • $1300
If the 3 week camp option was selected, please specify which weeks your child will be attending
Camper Release
Camper Release (List anyone, including parents, to whom your camper can be released)
*
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