Camper Name *

First Name

Last Name

Gender *

Male

Female

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Parent/Guardian Name *

First Name

Last Name

Address if different than camper

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Work Phone

(###)

###

####

Best way to contact you

Cell Phone

Email

Emergency Contact *

First Name

Last Name

Cell Phone *

(###)

###

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Work Phone *

(###)

###

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