Teen Summer Camp Application
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Mobile Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper T-shirt size (shirts are in adult sizes)
XXS
XS
S
M
L
XL
XXL
XXXL
Camp Session
French Language Session Camp: June 15-19
Basketball Clinic Session Camp: June 22-26
Leadership Training Session Camp: June 29-July 3
Arts and Crafts Session Camp: July 8-12
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Medical Information
Does the camper have allergies including asthma?
Please explain on the field provided
Is the camper currently under medication?
Please provide the details, the name of the medication and period of intake
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Contact Information in Case of Emergency
Name
First Name
Last Name
Contact Number
Format: (000) 000-0000.
Relation to camper
Name
First Name
Last Name
Contact Number
Format: (000) 000-0000.
Relation to camper
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Payment
Total amount for chosen camps
I would like to pay
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( X )
USD
Description
Signature of applicant or guardian representative
Submit
Should be Empty: