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first name:
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| last name: |
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| Address 1: |
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| Address 2: |
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| Contact info |
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| Date of birth: |
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| Previous Camp experience: |
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| List two references and their phone numbers: |
Reference #1
Reference #2 |
| Emergency contact info.: |
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| What do you expect from this summer?: |
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| What are your strengths?: |
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| What is your preferred age group?: |
infants and toddlers 4-6 7-9 10-12 13-14 |
| Comments: |
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| Date of application: |
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| Security Image |
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| Enter above Security Code |
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