Wild Within Teen Day Camp Registration
Primary/your email address *
All important information about this program will come via email, to the address you put here.
Note: If you are filling this form out for more than one person, please fill out a separate registration for each one.
2021 Camp Dates: Jul 26 – 30
PARTICIPANT INFO
Teen's First Name *
Teen Preferred Name or Nickname, if different from First Name
Teen's Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Age on 1st day of program *
Gender
Preferred Pronouns
Racial Identity (optional)
Sibling names and ages
Teen's email (if different from the person filling this out)
What size T-shirt might fit this teen on the 1st day of camp?
We give everyone a free T-shirt!
Clear selection
Next
Never submit passwords through Google Forms.
This form was created inside of Vermont Wilderness School.