Parent Name:
Email:
Telephone:
Address:
City:
State:
Zip:
Camper Name:
Age:
Birthdate:
In case of emergency, notify:
Phone:
Religious/Church Affiliation:
T-shirt size:
Most recent grade completed:
Food allergies:
Penicillin or other drug allergies (list):
Insect stings /bites:
Poison sumac, oak, or ivy allergies(list):
ANY current medications (list):
Other Information:
June 30 - July 3
June 23 - 26
July 7 - 10
July 14 - 17
July 21 - 24
July 28 - 31
M.A.D.
Instrument:
Do you have one?
Music Level:
Drama Level:
