EmailMe Form - CampXtreme 2015 Registration Form

Child's Name *
Date of Birth *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Parent's Name *
Phone *
### - ### - ####
Email
Grade Last Completed *
School Last Attended *
EMERGENCY Contact *
Emergency Contact Phone *
### - ### - ####
Relationship to Child
Please list any allergies:
First Track Choice *
Each child will be attending one (1) track time during this camp. Please choose two tracks, selecting your first choice above in the First Track Choice box and your second choice in the Second Track Choice box. We will do our best to assign each child to the first track of their choosing.
Second Track Choice *