Name* First Last Gender Male Female Birthday* Month Day Year Current Grade* School Attending* Does your child have any allergies?* Yes No Please List All Allergies*Does your child require any special accommodations?* Yes No What accommodations does your child need?* Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Individuals Authorized for Pickup* Emergency Contact Name Emergency Contact PhoneParent/GuardiansParent/Guardian Name* First Last Relationship* Mother Father How did you hear about us?* Which camp are you interested in?Robots, Volcanoes & Art CampFabric Art Creative CampPoetic Art CampTotal $ 0.00 CAD CAPTCHA
