2023 Online Registration

I need assistance paying for my week/weeks of camp: *

Yes No Maybe

The cost for a week of camp is $125 per person. Please specify how much of the expense you can cover. *

Please select which week(s) you plan to attend:

Note: We have consolidated the form this year to simplify the process. Please select all weeks you intend to attend as a camper and those you intend to attend as a staff member.

Weeks of Camp as Camper *

Weeks of Camp as Staff *

Full Name *

First

Last

Gender *

Male Female

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

E-Mail Address *

Parent/Guardian Name *

First

Last

Phone Number #1 *

Parent/Guardian E-Mail Address *

Phone Number #2 *

Emergency Contact Name *

First

Last

Relationship *

The following individuals may pick me (registrant) up from camp:
(Staff Members - please list yourself.)

Name *

First

Last

Name *

First

Last

Phone Number *

Medical Insurance

Medications: Please check medications the nurse can give you.

Please list any current medications and dosages for each.

Please list any current medical issues, disabilities, and/or chronic disease.

Please list any dietary modifications.

Please list any other information you need to share.

Online Registration 2023