Wait-List Form

Wait-List Form
Select all weeks you wish to be put on the waitlist for:

May 27-30 AMJune 2-6 AMJune 16-20 AM
Camper Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*

Area CodePhone Number
E-mail*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Should be Empty: