Our Value Building Skills Getting Started 36 hour challenge
 
Customer Information
Camper's Name   Sex     
 
Mailing Address   Date of Birth  Age
 
Town   State Zip
 
School   Grade Home Phone
 
(xxx-xxx-xxxx)
Parent email id      

 
Mother Name   Employer's name   

 

Employer Town   Day Phone  Cell Phone 

 
(xxx-xxx-xxxx)

Father Name   Employer's name   

 

Employer Town   Day Phone  Cell Phone 

 
(xxx-xxx-xxxx)
In case parent cannot be reached :    
 1.Emergency name & Phone
  
 2. Emergency name & Phone 
People other than parents authorized to pick up child      
     
How did you hear of our program?    
Mailer  Your child's school
 Word of Mouth  other
     
   
                                                                            
     
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