Campers Last Name *

Camper First Name *

Age at time of camp? *

Camper First Name (second child)

Age at time of camp?

Camper First Name (third child)

Age at time of camp?

Click First Week of Camp *

Click Second Week of Camp

Click Third Week of Camp

Parent/Guardian One Name *

Parent/Guardian One Phone Number *

Parent/Guardian Two Name

Parent/Guardian Two Number

Street Address *

City, State *

Zip Code *

School *

Are they coming with a friend/s? (Please List)

Grand Total: $375.00 per camper per week / -25 per camper per week: for early registration until March 15th. / -25 for second camper per week/ -50 for third camper per week/ -25 for second week per camper per week. Example: Camper one 375-25=350 Camper two 375-25-25=325 Total: $675.00 *

Form of Payment *