Name of Adult (Primary Contact) *

First Name

Last Name

Name of 2nd Adult

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Name of Child

First Name

Last Name

Date of Birth of Child

MM

DD

YYYY

Name of 2nd Child

Skip if only one child is attending Camp

First Name

Last Name

Date of Birth of 2nd Child

MM

DD

YYYY

Name of 3rd Child

Skip if only two children are attending Camp

First Name

Last Name

Date of Birth of 3rd Child

MM

DD

YYYY

Name of 4th Child

Skip if only three children are attending Camp

First Name

Last Name

Date of Birth of 4th Child

MM

DD

YYYY

Will this be your first time at Camp?

Yes!

No