* First Name:  * Last Name:

*Address1:

  Address2:

*City: *State: *Zipcode:

*Telephone: () -

*Camper's Birthdate: 01 02 03 04 05 06 07 08 09 10 11 12 / 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 09 08 07 06 05 04 03 02 01 / \n2004\n2003\n2002\n2001\n2000\n1999\n1998\n1997\n1996\n1995\n1994\n1993\n (MM/DD/YYYY)

*My Camper is a Boy Girl

*I would like my child to attend the following term (Select One Below):

\nJune 06 - June 12 :::Adventure Camp AC-1 ::: $795 June 13 - June 19 :::Adventure Camp AC-2 ::: $795 June 20 - June 26 :::Adventure Camp AC-3 ::: $795 June 27 - July 03 :::Adventure Camp AC-4 ::: $795 July 04 - July 10 :::Adventure Camp AC-5 ::: $795 July 11 - July 17 :::Adventure Camp AC-6 ::: $795 July 18 - July 25 :::Adventure Camp AC-7::: $795 July 25 - July 31 :::Adventure AC-8::: $795 June 6 - June 19 :::Summer's Best SBTW 1::: $1600 June 20 - July 3 :::Summer's Best SBTW 2::: $1600 July 4 - July 17 :::Summer's Best SBTW 3::: $1600 July 18 - July 31 :::Summer's Best SBTW 4::: $1600

Notes and / or Comments:

Parent or Legal Guardian:

*First Name: * Last Name:

Relationship to Camper:

*Your Email Address:

Check this box if the Camper's Address and your address is the same.

*Address 1 :

  Address 2 :

*City: *State:  *Zipcode:

*Home Phone: ( ) -

  Office Phone: ( ) -