Camper Information
Camper First Name *
Camper Last Name *
Date of Birth *
Grade Entering this Fall *
– Select a Grade – Grades 2 - 3 Grades 4 - 5 Grades 6-8 Grades K-1 Preschool
Gender *
– Select a Gender – Male Female
Address (line 1) *
Address (line 2)
City
State
– Select a State – Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Dietary and special needs, allergies or medications (please list)