Camper First Name *
Camper Last Name *
Status
 New Camper 
 Return Camper 
Session Choice *
 Work Party Weekend: for parents, alumni, volunteers, staff, June 14th-16th w/ rafting on 17th 
 Session 1: 10-12 yearolds, June 23rd-July 20th 2013 
 Session 2: teenagers, July 22nd-August 3rd 2013 
Date of Birth

MM		/
DD		/
YYYY
Age at the Start of Camp *
 9 
 10 
 11 
 12 
 13 
 14 
 15 
 16 
 17 
 old 
Sex
 Female 
 Male 

1st Parent Contact

First Name *
Last Name *
Mailing Address *
City *
State
ZIP *
Country
Phone *
Email

2nd Parent Contact (If different from above)

First Name
Last Name
Mailing Address
City
State
ZIP
Country
Phone
Email

Camper Contact (Optional)

Phone
Email

Why do you want to come to camp?
Comments or Questions
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