Summer Camp Application
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
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
Camp Session
Session Camp: July 17-19
Session Camp: July 24-26
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
Back
Next
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
Payment
Total amount for chosen camps
I would like to pay
prev
next
( X )
USD
Description
Signature of applicant or guardian representative
Submit
Submit
Should be Empty: