Big Heart Ranch 2020 Camper Registration

Camp Registration

If you do not meet the requirements, you will not be able to submit the registration form. We appreciate your honesty.
Do you live in the geographic area impacted by the Woolsey Fire?*

YesNo
Did you lose your home in the Woolsey Fire?*

YesNo
What is your annual household income?*

Under $45,000Between $45,000 and $65,000Between $65,000 and $80,000Between $80,000 and $100,000Over $100,000

Guardian Name*

First NameLast Name
Camper Name*

First NameLast Name
Camper Age*
Camp is for ages 3 to 9
Relationship to Camper*
Example: mother, father, grandmother, etc.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Emergency Contact*
Full Name
Emergency Contact Number*

Area CodePhone Number

Liability Waiver
Signature*

Clear
Date Signed*

MonthDayYear
Date
If you do not meet the requirements for attending this camp, you will not be able to submit the registration form. We appreciate your honesty.
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