Summer Camp Enrollment Form

2023 Summer Camp Registration
CAMPER INFORMATION:
Individual Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Name of School/ Organization*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number

Area CodePhone Number
Medical Concerns
* Please list all medications to be administered.
Choose Your Camp

Week 1 Day Camp (ages 6-17)Week 2 Day Camp (ages 6-17)Week 3 Day Camp (ages 6-17)Week 4 Day Camp (ages 6-17)
Choose Your Camp Week(s)
Example: Week 1,2,3,4
T-Shirt size:
Example: Adult Large, Youth Medium
Should be Empty:

2023 Summer Camp Registration