2020 Registration

Counselor Information

Please complete ALL questions.
Counselor's Name *

First Name Last Name
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Email *
example@example.com
I am applying to serve as a:

Select counselor position and session number.
Select Counselor position *
Select .
Select Session *
Select Session Attending.
Background Check

ALL counselor's, Cooks, and Session Staff are required to complete a back ground check in order to participate in a camping session.
Full Legal Name *

First Name Middle Name Last Name
Birth Date: *

Month Day Year
Date
Driver's License Number *
Please enter your number and State
Camp T-Shirt

A t-shirt is included in the registration fee. Please select the desired size for your camper.
Camper T-Shirt Size *
Emergency/Alternate Contact Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Photo/Video Release

If given permission, we may use your camper's image for publicity purposes.
I allow camp use photos/videos. *

Yes No
PAYMENT

Please select the appropriate form of payment.

My Products

Session ONE $ 50.00

July 19 - July 25th, Director: James Malone

Session THREE $ 50.00

June 15th - 20th, Director: Sterling McDonald

Session FIVE $ 50.00

June 29th - July 4th, Director: Tony Fitzgerald

Enter coupon

Total $ 0.00

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Counselor Information