Parent/Guardian Name:

Address:

City: State: Zip:

Home Phone: Work Phone: Mobile Phone:

Email:

Girl: Boy: Age: Birthday: T-Shirt Size :

School: Grade exiting this Spring : Grade entering this Fall :

Is there another camper with whom you'd lie to share a cabin?
(Please note: This is a preference only, not a guarantee. It may not be possible to accommodate all requests.)

I certify that I am the parent or guardian, I am over 18, and have read and agree wih the conditions of enrollment: