Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone *

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Father's Name

First Name

Last Name

Father's Telephone

(###)

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Mother's Name

First Name

Last Name

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Size(s) of Additional T-Shirts

Please select the same amount of sizes as the number you entered above.

Youth Extra Small

Youth Small

Youth Medium

Youth Large

Youth Extra Large

Adult Extra Small

Adult Small

Adult Medium

Adult Large

Adult Extra Large

Please check all applicable fields: *

Note: Payment in Full includes $100 deposit per camper.

Application Fee ($25)

Non-Refundable Camp Deposit to reserve camper's space ($100 per child)

Payment in Full - Early Bird Fee for FIRST CHILD (received before 3/30) ($475)

Payment in Full - FIRST CHILD (received after 3/30) ($500)

Payment in Full - ADDITIONAL CHILDREN ($425 per child)

Low Ropes Challenge Course - 7th and 8th Grade ONLY ($14 per child)

Additional T-Shirts ($10 per shirt)