Please fill out this form to register online or via mail.

Camper's Information
* First Name:   * Last Name:   Nickname:

* Date of Birth: Month 01 02 03 04 05 06 07 08 09 10 11 12   Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002    * Sex: Male Female

* Current School    * Current Grade 1 2 3 4 5 6 7 8 9 10 11 12  

Select Session(s):
 Session 1 (13 days, Ages 7-16) ...... Sat. June 26 to Fri. July 9 .................... $1250 

 Session 2 (21 days, Ages 8-16) ...... Sun. July 11 to Sun. Aug. 1 .................... $1760 

 Session 3 (19 days, Ages 8-16) ...... Tues. Aug. 3 to Sun. Aug. 22 .................... $1690

*Campers may register for more than one session.
*We suggest you make note of dates on your calendar when you register.

Parent or Guardian Contact Information
Parent/Guardian #1:
Mr. Mrs. Ms Dr.   * First Name:    * Last Name:   
Parent/Guardian #2:

Mr. Mrs. Ms Dr.   First Name:    Last Name:   

* Address Line 1:

Address Line 2:

* City: * State/Province: Select One Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory   * ZIP:

* Home Phone:      Work Phone:   

Mobile Phone:   

Email:

If you cannot be reached in the event of an emergency, who should we contact?
* Emergency Contact: * Phone: