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Parental Permission  
Camper Name *
Camper Age *
Sex *
Address *
City *
State *
Zip code *
Telephone Number *
Parent/Guardian Name *
Email *
Emergency Contact *
Emergency Contact Telephone
Insurance Company
Policy Holder
Policy #
Group #
Physician Name
Physician Telephone
Allergies (please list)
Medication(s) (please list)
How did you hear about the camp?
   

Campers shall be rewarded a full refund of camp dues, minus the $35.00 processing fee, up until June 7th, 2010 for any illness, sickness, injury, or other unforeseen event that might prevent he/she from participating in camp activities. After June 7th, 2010 all sales will be final and no refunds will be awarded.

I agree to above authorization *
Signature of Parent