Camper Name Birth Date Home Phone Number Mobile Number Email Address Desired Name Tag Primary Address City State Zip Select Camp shirt size Small Medium Large Extra-Large Please provide any medical or dietary restrictions you have How did you hear about Camp? Email Facebook Print Ads Radio Referral School Official Others High School Name High School Address City State Zip High School Phone Number Year in School Freshman (9th) Sophomore (10th) Junior (11th) Senior (12th) Current GPA Parent/Guardian's Name Contact Phone Number E-mail Address Emergency Contact Name Emergency Contact Phone Number Relationship to Student In 300 words or less, please describe your reasons for wishing to attend this camp. Send