Summer Camp Application
Camper 1 - Name
First Name
Middle Name
Last Name
Camper 1 - Date of Birth
-
Month
-
Day
Year
Date
Camper 1 - Gender
Male
Female
Camper 2 - Name
First Name
Middle Name
Last Name
Camper 2 - Date of Birth
-
Month
-
Day
Year
Date
Camper 2 - Gender
Male
Female
Email
example@example.com
Phone Number
Mobile Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper 1 T-shirt size (shirts are in adult sizes)
XXS
XS
S
M
L
XL
XXL
XXXL
Camper 2 T-shirt size (shirts are in adult sizes)
XXS
XS
S
M
L
XL
XXL
XXXL
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Medical Information
Please use space below to list information for each camper if you have more than one camper.
Does the camper(s) have allergies including asthma?
Please explain on the field provided including any food the camper is allergic to
Is the camper(s) currently under medication?
Please provide the details, the name of the medication and period of intake
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Contact Information in Case of Emergency
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to camper(s)
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to camper(s)
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My Products
prev
next
( X )
Camp Registration Fee
$
75.00
Registration fee holds your child’s spot. Registration is non refundable.
Quantity
1
2
3
4
5
6
7
8
9
Total
$
0.00
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Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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