1) Please check which event(s) this camper will be attending:
____ Junior Week #1 (June 13-18) : Ages 8-11, $135 per camper
____ Junior High Week (June 20-25) : Ages 12-14, $135 per camper
____ Senior High Week (June 27-July 2) : Ages 15-18, $135 per camper
____ Junior Week #2 (July 4-9) : Ages 8-11, $135 per camper
2) Camper Information:
Camper's Full Name:___________________________________________
Street Address:_______________________________________________________________
City:_______________________ State:__________ Zip Code:_______________
Gender:___________ Date of Birth:____________________
Emergency Contact:_________________________________ Emergency Phone:____________
3) Parent or Guardian Information:
Full Name:___________________________________________
Relationship to Camper:______________________________
Street Address:________________________________________________________________
City:_______________________ State:__________ Zip Code:_______________
Primary Phone: __________________
Other Phone Numbers:__________________________________________________________
4) Additional Information
-Please list any allergies to food, medication, or environment the camper has.
-Please list any special medications the camper will require during his/her stay. NOTE that any medications
will need to be given to our staff when you arrive. Please enclose the medications in a zip-lock bag
along with written directions concerning dosage amounts and times.
-Please write any other important information here such as desired cabin mates or restricted activities.
5) Final Checklist:
To make sure your spot is reserved, the following must be done.
-fill out registration from
-fill out medical release form
-mail in these two forms along with your deposit