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Camper Details
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First Name
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Last Name
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Confirmation Email
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Parent/Guardian Name(s)
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Phone Number
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Street Address
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City
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State
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Country
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Postal Code
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Date of Birth
*
Sex
*
Age (As of September 2022)
*
Grade (As of September 2022)
Cabin Mate(s) Request
Does this camper receive any type of additional support at school?
Yes
No
Is this camper under the care of a physician for any ongoing physical, emotional or developmental conditions?
Yes
No
Has this camper experienced any type of physical, mental or emotional trauma or stress?
Yes
No
If yes to any of the above questions, please provide additional information below. All information will be kept confidential.
Additional Comments?
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Name of Primary Contact (parent/guardian) while at camp
*
Emergency Phone Number
Street Address if different from camper
City
Province
Country
Postal Code
Secondary Contact (if parent/guardian can't be reached.
Phone Number
I give permission to use pictures of the above named camper for promotion.
Yes
No
Name of parent/guardian giving permission.
SUBMIT
Youth Camp (Grades 9-12)
Jul 02, 2:00 p.m. – Jul 08, 11:00 a.m.
$400.00
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