Boys/Girls Camp

Flyer

Email address *

First name *

Last name *

Address 1 *

City *

State *

ZIP Code *

Cell Phone Number *

Parent Name *

Emergancy Contact *

Emergancy Contact Phone *

Age Group *

4-6 ($75) 7-10 ($100) 11-16 ($100)

Insurance Plan *

Policy Holders Name *

Policy/Group No. *

Is camper allergic to any medications? (If so what?) *

Any medication being sent with camper? *

Camper T-Shirt Sizes *

YXS YS YM YL YXL AS AM AL AXL

Grade Next Year? *

Campers Age? *

* required field