What's your name? *

First

Last

How old are you? *

Email *

Phone (or your parent's phone number) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How did you hear about the camp?

What made you excited about it?

Do you have any allergies or special medical conditions? *

Yes
No

Please describe.

What is your t-shirt size?

Do you have any comments or questions?

Speak up now, or forever hold your peace!

In Case of Emergency (if under 18)

I hereby give permission to the physician selected by the camp to hospitalize and/or secure necessary treatment (including injection, anesthesia, or surgery, as needed) for my child as named above.

Full Name of Parent/Guardian

Phone # of Parent/Guardian

Total Registration Fee

Price: $ 187.00