M4 Campout Single Camper Form

M4 Campout

When: Friday, June 5th, 2020 @ 4 PM - Sunday, June 7th, 2020 @ 12 PM
Registration Deadline: Friday, May 31st, 2020

Ages: 7 years - 12 years
Multi-Camper Family Discount: $35 per camper
Water bottle and/or backpack purchaseavailable below.

Please fill out the fields for each camper separately. Upon checkout, you will be able to select how many campers you have and check out securely via PayPal. Please fill out all fields for each camper that is attending. If not applicable, please enter "n/a."

Registration (Single Camper Only):

Camper's Name*

Camper's Age (as of 6/2/2019)*

Parent or Guardian Name*

Grade Entering Fall 2019*

Known Medical Conditions

List of Medications (if applicable)

Any Known Allergies

Gender*

MaleFemale

Parent or Guardian Name:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number*

Area CodePhone Number

Other Contact/Emergency Contact Name*

Other Phone/Emergency Phone*

Area CodePhone Number

Authorization and release of liability (noted in packet) shall remain effective until terminated in writing.

Parent or Guardian Signature:*

Please make your selection(s) below. *

Registration Fee (1 Camper)$35.00

Water Bottle$10.00

Backpack (Must purchase or bring from prior year)$7.00

Total $0.00