Summer Youth Camp Applicatipn

All camp weeks are for youth ages 7 to 14. Lunches will be provided. Camp hours are 9am to 3pm.

Your Child's Name *

First

Last

Child's Age *

Any Additional Children? *

Child's Name *

First

Last

Child's Age *

Child's Name (optional)

First

Last

Child's Age (optional)

Parent/Guardian Name *

First

Last

Phone *

Secondary Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact *

First

Last

Emergency Contact Phone

Does your child/children have any allergies we should be aware of?

if other, please specify *

does your child/children take any medication we should be aware of? *

If so, please specificy which medications, how much should be taken, when and how.

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