Senior II Camp 2021 Registration

Ages 15-18

JULY 18-24, 2021

One registration per camper.

In order for registration to be completed, you must turn in a release of liability form along with medical insurance information.

Last Name

First Name

Name Camper Goes By

Gender

Date of Birth

YYYY

Age of Camper When Camp Starts

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Were You a Camper in 2019?

Yes

Attending Responsible Adult

First Name

Last Name

Special Health Notes

Please list any health related issues (i.e. allergies, medications, etc.).