Camper Name *

First Name

Last Name

Camper Date of Birth *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Are there any allergies, medications, or medical conditions we should be aware of? *

Yes

No

In case, of emergency, I authorize permission for camper to be treated *

Yes

No

I consent for photos to be taken of my student. *

These images may be used for future event promotion on website, social pages, etc.

Yes

No

I understand that the cost of $75 per camper is due before participation in camp activities. *

Payment accepted via ApplePay, CashApp, or Zelle to Jessica

Yes

No

Are you interested in volunteering at camp?

Yes

No