Camper Registration Form
Parent/Guardian Name
*
First Name
Last Name
Relationship to Camper
*
Ex: Mom, Dad, etc.
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Parent/Guardian Email
*
Confirmation Email
example@example.com
Family Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper Preferred Name
*
First Name
Last Name
Camper Legal Name (if different)
First Name
Last Name
Camper Phone Number
*
-
Area Code
Phone Number
Camper Email
*
Confirmation Email
example@example.com
Camper Address (if different than parent/guardian)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list Camper's social media handles for their top three platforms.
Which camp are you registering for?
*
Los Angeles
Provincetown Week 1
Provincetown Week 2
Provincetown Week 3
New York City
Camper Date of Birth
*
-
Month
-
Day
Year
Date
How old will you be during camp?
*
Will you have a birthday during camp?
*
Yes
No
What is your t-shirt size?
*
Small
Medium
Large
X-Large
XX-Large
T-shirts are unisex
What is your race/ethnicity?
*
Black / African American
Latinx / Hispanic
Asian Pacific Islander
Caucasian (Non-Hispanic)
Native American
Multi Racial
Other
What is your gender identity?
*
Cis Female
Cis Male
Trans Female
Trans Male
Nonbinary
Genderqueer
Questioning
Other
What are you preferred pronouns?
*
He/Him
She/Her
They/Them
He/They
She/They
They/He
They/She
She/He
He/She
He/She/They
She/He/They
Other
What is your sexual identity?
*
Pansexual
Queer
Bisexual
Lesbian
Gay
Straight
Questioning
Other
Prefer Not to Say
How did you first learn about Camp Lightbulb?
*
Website
Email Blasts
Facebook/Twitter
Friend
Parent
Community Event
Attended Last Year
Other
Are you currently in high school?
*
Yes
No
If yes, which grade are you in?
*
Who are your LGBTQ+ heroes/icons?
*
List 3 words you would use to describe yourself.
*
What are your hobbies, interests and/or extracurricular activities? What do you do for fun?
*
What are you most looking forward to at Camp Lightbulb?
*
What are you most apprehensive about?
*
On a scale from 1 to 10, how would you rate your swimming ability?
*
1 = Weakest / 10 = Strongest
On a scale from 1 to 10, how would you rate your biking ability?
*
1 = Weakest / 10 = Strongst
The camp experience could push your comfort zones. For example, sharing a room with others, trying a new physical activity or having a frank discussion about bullying. What kind of support will you need to navigate these or other challenging situations?
*
Have you spent time away from home before or attended a sleep away camp?
*
Yes
No
If yes, how long were you away from home?
*
Including this camp, and virtual camp, how many times have you attended Camp Lightbulb?
*
Please share any special requests you may have.
Please share anything else you would like us to know about you.
Submit
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