Parent Name *

First Name

Last Name

Phone *

(###)

###

####

Camper's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

I'm interested in registering for the following weeks: *

Please check off the weeks your are considering:

Week #1 June 30 - July 3

Week #2 July 7 - 11

Week #3 July 14 - 18

Week #4 July 21 - 25

Week #5 July 28 - Aug 1