Form Center

2. A registration form must be submitted for each camper.

   
   

   
   

4. Select your camp schedule session

   1. July 13-17, 2026 Ages 10-12 Years Old ($165 per child)
   2. July 27 - July 31, 2026 Ages 8-10 Years Old ($165 per child)
6. After payment submission you will be redirected to payment checkout.
8. Child Information
10. First Name
11. Last Name
13. Child's Code Word
14. Rising Grade (2026-27)
15. Birthday
16. Age
18. Address1
20. City
21. State
22. Zip
24. Health Care Information
26. Name of Physician
27. Physician Phone #
29. Address
31. City
32. State
33. Zip
35. Disability or Recurring Illness
36. Activities Limited by a Physician
38. Additional information about the camper we should be aware of.
40. Dietary Modifications/Food Allergies
42. Parent/Guardian Information
44. Parent/Guardian Name
45. Relationship to Child
47. Address if Different Than Above
49. City
50. State
51. Zip
53. Home Phone#
54. Cell Phone #
55. Work Phone #
57. Email
59. Employer
60. Employer Phone #
62. Parent/Guardian Name
63. Relationship to Child
65. Address if Different Than Above
67. City
68. State
69. Zip
71. Home Phone #
72. Cell Phone #
73. Work Phone #
75. Email
77. Employer
78. Employer Phone #
80. Authorized Pick Up
    Persons other than parent/guardian authorized to pick up the camper. Must use the Code Word at pick up.
82. Name
83. Relationship to Child
85. Daytime Phone #
86. Other Phone #
88. Name
89. Relationship to Child
91. Daytime Phone #
92. Other Phone #
94. Name
95. Relationship to Child
97. Daytime #
98. Other Phone #
Leave This Blank:


100. 1. Receive an email copy of this form.
101. Email address

     This field is not part of the form submission.

102. Submit

* indicates a required field