Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birth Date *

MM

DD

YYYY

Emergency Contact Name *

First Name

Last Name

Emergency Contact's Phone Number *

(###)

###

####

Do You Need a Handicap Room?

Yes

No

Please read the Medical Agreement, Acknowledgement or Risk, Release, and Waiver. By clicking the I AGREE box below and typing your name where indicated, you are acknowledging your assent to the terms of the Medical Agreement, Acknowledgement or Risk, Release, and Waiver and intention to be legally bound by the Medical Agreement, Acknowledgement or Risk, Release, and Waiver. *

I AGREE

Please read the Agreement, Acknowledgment of Risk, Release, and Waiver. By clicking the I AGREE box below and typing your name where indicated, you are acknowledging your assent to the terms of the Agreement, Acknowledgment of Risk, Release, and Waiver and intention to be legally bound by the Agreement, Acknowledgment of Risk, Release, and Waiver. *

I AGREE

Please read the Consent and Release for Interview, Photograph, Video Recording, and/or Media Posting. By clicking the I AGREE box below and typing your name where indicated, you are acknowledging your assent to the terms of the Consent and Release for Interview, Photograph, Video Recording, and/or Media Posting and intention to be legally bound by the Consent and Release for Interview, Photograph, Video Recording, and/or Media Posting. *

I AGREE

I DO NOT AGREE

I am registering as a: *

Day/Night Camper ($75 Camp Fee)

Day Camper Only ($45 Camp Fee)