Camper's Name

First Name

Last Name

Age *

6

7

8

9

10

Current Grade

First

Second

Third

Fourth

Session Attending *

First 4 weeks - (June 14th–July 9th)

Second 4 weeks - (July 12th–August 6th)

All 8 weeks - (June 14th–August 6th)

Parent 1 *

First Name

Last Name

Parent 2

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country