On-line Registration. Step 1 of 3

Each person should register separately. Select your Group or Organization or, select "none" and then select the program you wish to attend.
*=Required Field
 
Group/Organization Affiliation*
Enter optional Group or Organization Name if not found in the list above

Select Program/Event*

Attendee's First Name*

Last Name*

Gender*
 (Used for housing purposes only)

Birth Date
 date picker  

Mailing Address*

Address Line 2

City

State

ZIP Code

Primary Phone*

Secondary Phone

Email*

Parent/Guardian Last Name

Parent/Guardian First Name

Parent/Guardian Relationship

Parent/Guardian E-mail
(Put a comma(,) or semicolon(;) between multiple e-mail addresses)

Roommate Request

Activity Restrictions*
Describe any activity restrictions while at camp. Enter "None" if you don't have any.

Diet*
Describe any dietary restrictions or food allergies. Enter “none” if you don’t have any.

Allergies*
Describe any other allergies. Enter “none” if you don’t have any.
 
Medical Treatments*
Describe any past medical treatments relevant to participating in camp activities. Enter “None” if you don’t have any.
Last Tetanus shot
Enter approximate month and year of last Tetanus shot. If for religious and/or other reasons, you choose to not disclose these records please enter "No"
Approx date of last Medical Exam
Are other immunizations current?
 
If no, please list here
List all medications sent to camp*
All medications must be sent in the prescription bottle with label. List all medications sent or enter "None"
May Tylenol, Benadryl, Cough Drops or Tums be administered?*
 
Medical Restrictions*
Describe any current medical and/or behavioral conditions that require medications, treatment, or special restrictions while at camp. Enter "None" if you don't have any.
Physician:
Prefix
First Name
Last Name
Suffix
Physician's Address
Address Line 2
City
State
ZIP Code
Physician's Phone
Medical Insurance Company
Policy Number
 
Emergency Contact:
Full Name*
Relationship*
Primary Phone*
Secondary Phone

Scholarship Assistance

Scholarships are based upon income eligibility. Financial information must be complete in order to process scholarships.

Total number of people in household
#  

Total annual household gross income from any source
$