Summer Camp Application
June 26 - 30, 2022, Crystal Springs, ND
Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Parent Email
*
example@example.com
Phone Number
Mobile Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper T-shirt size (shirts are in adult sizes)
*
XXS
XS
S
M
L
XL
XXL
XXXL
Back
Next
Medical Information
Does the camper have allergies including asthma?
*
Please explain on the field provided
Is the camper 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
*
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to camper
Back
Next
Signature of applicant or guardian representative
*
Clear
Back
Next
Camper Fees based on Age
prev
next
( X )
11 & 12 years Old
$
146.00
Camp Fee
13 years old & Above
$
175.00
Camp Fee
Enter coupon
Apply
Total
$
0.00
Credit Card
Submit
Should be Empty: