Camp Registration Form 2026

Camp Registration Form 2026

Registration fee: $125
Camper Information

Open to 3rd graders-12th graders only
Name

First NameLast Name
Date of birth

MonthDayYear
Date
Age
Gender
Grade completed
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact
Relationship
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information
Allergies (type "none" if there are no allergies)
Medications (type "none" if there are no medications)
Medical conditions (type "none" if there are no medical conditions)
Insurance Provider
Policy Number
Physician's Name

First NameLast Name
Physician's Number
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about camp?
T-shirt size
Permissions: I give permission for my child to attend camp.
Permissions: I give permission for emergency medical treatment if needed.
Permissions: I give permission for photos/video for promotional use.
Permissions: I understand camp rules must be followed.
Office Use Only:

Registration Fee $125

Amount Paid:______________

Balance Due:______________

Payment Method:___________
I understand that clicking Submit acts as my signature.
Should be Empty:

Camper Information