Name *

First Name

Last Name

Phone Number *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Week Availability (M-F) *

Prep Week (June 16th-20th)

Week 1 (June 23rd to 27th)

Week 2 (June 30th to July 3rd)

Week 3 (July 7th to 11th)

Week 4 (July 14th to 18th)

Week 5 (July 21st to 25th)

Week 6 (July 28th to August 1st)

Week 7 (August 4th to 6th)

Areas of Interest/Skills *

Rookie Camp (Ages 4-7)

Sports

Arts & Crafts

Office

Setup (Activity Engineering)

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

By submitting this application, I certify that all information is true, accurate, and complete to the best of my knowledge. *

Yes, I certify.

No, I do not certify.