2018 Camper Registration Form
Agassiz Village Summer Camp
Camper Section
Pick Your Session(s)! *
2 session maximum!
Required
Camper First Name *
Your answer
Camper Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age at time of Camp *
Your answer
Gender *
Address 1 *
Your answer
Address 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Current Grade
Your answer
School *
Your answer
Special or Gifted Class
If yes, then please explain
Your answer
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