PowerCamp Registration
Health . Safety . Fitness
Age Group
*
Please Select
Ages 5-8
Ages 9-12
T-Shirt Size
*
Please Select
Youth Extra Small
Youth Small
Youth Medium
Youth Large
Small
Medium
Large
Extra Large
Participant Name
*
First Name
Middle Name
Last Name
Participant Birth Date
*
-
Month
-
Day
Year
Date
Parent or Guardian Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Emergency Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Medical History / Known Allergies / Special Instructions
Please verify that you are human
*
My Products
prev
next
( X )
PowerCamp
June 17th - 21st 9am - Noon
$
195.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Submit
Should be Empty: