Junior Camp 2019 Registration

Ages 9-11

June 10-14

One registration per camper.

In order for registration to be completed, you must turn in a release of liability form along with medical insurance information.

Last Name *

First Name *

Name Camper Goes By *

Gender *

Date of Birth *

Date of Birth

YYYY

Age of Camper When Camp Starts *

Email Address *

Phone *

Phone

(###)

###

####

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Were You a Camper in 2017? *

Yes

Attending Responsible Adult *

Attending Responsible Adult

Attending responsible adult is required for Junior Camp.

First Name

Last Name

Special Health Notes

Please list any health related issues (i.e. allergies, medications, etc.).