Summer Camp 2023 Application
June 25 - 29, 2023, 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
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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
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Signature of applicant or guardian representative
*
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Camper Fees based on Age
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( X )
11 &12 years old
$
175.00
Camp Fee
Quantity
1
2
3
4
5
6
7
8
9
10
13 years old & Above
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card
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