* indicates a required field

Name of camper (first and last name): *

Email: *

Phone: *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Will your child be carpooling with anyone during camp? *
YesNo
If yes, please list name:

Will your child be picked up by anything else besides the listed emergency contact? *
YesNo
If yes, list name(s) and contact phone number(s):

Please list any questions or further information you would like to give us: