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Camp Registration

* indicates required fields.
First Name*   Last Name*
Street Address*

City*   State*   Zip*

Home Phone*   Cell Phone

How did you hear about us?

Student First Name*   Student Last Name*
Student Age*

Child Grade in September (for kids and teens only)


Emergency Contact Name*   Emergency Contact Phone*
Person Authorized to Pick Up Child (for Adult Camp, type "n/a")*

Special Instructions