Participant's Full Name
First Name
Last Name
Age
Birthday
Month
Day
Year
Parent/Guardian Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
0
United
States
Country
Postal / Zip Code
Afghanistan
Albania
Phone Number (Home)
Algeria
Area Code
Phone NumberAmerican Samoa
Andorra
Angola
Work
Anguilla
Area Code
Phone NumberAntigua and Barbuda
Argentina
Cell
Armenia
Area Code
Phone NumberAruba
Australia
Text messages are sent for communicating camp alerts only.Austria
Are you able to receive text messages?
Azerbaijan
❏ Yes
❏ No
The Bahamas
Bahrain
E-mail
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Home-school ❏ Charter
Type of School
❏ Public
❏ Private
❏Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Current School (as of May 2016)
Brunei Rising Grade
Bulgaria
Burkina Faso
Burundi
Cambodia
Race
Gender
Cameroon
Female
❏ African American
Canada❏
Cape Verde
❏ Asian
❏ Male
Cayman Islands
❏ Caucasian
Central African Republic
❏ Hispanic/Latino
Chad
Chile
People's Republic of China
Republic of China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Facebook
Twitter
Cook Islands
Costa
Rica
❍ Yes
❍ No
❍ Yes
❍
Cote d'Ivoire
Croatia
Cuba Twitter Handle
Facebook Name
Cyprus
Czech Republic
Democratic Republic of the
Congo
Denmark
Djibouti
Dominica
Dominican Republic
Full Name 1
Ecuador
First Name
Last
Name
Egypt
El Salvador
Equatorial Guinea
Relationship
Phone Number
Eritrea
Estonia
Ethiopia
Falkland Islands
Phone Number
Faroe Islands
Fiji
Finland
Full Name 2
France
French
First Name
Last NamePolynesia
Gabon
The Gambia
Relationship
GeorgiaPhone Number
Germany
Ghana
Gibraltar
Greece Phone Number
Greenland
Grenada
Guadeloupe
Full Name 3
Guam
First Name
Last Name
Guatemala
Guernsey
GuineaPhone Number
Relationship
Guinea-Bissau
Guyana
Haiti
HondurasPhone Number
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta Date
Parent Name
Marshall Islands
Martinique
Mauritania
First Name
Last Name
Month
Day
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of
Parent Name
Date
Northern
Cyprus
Northern Mariana
Norway
First Name
Last Name
Day
Oman Month
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the
Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Parent Name
Date
Senegal
Serbia
Seychelles
First Name
Last Name
Month
Day
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria
Parent Name
Date Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
TunisiaMonth
First Name
Last Name
Day
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Participant's Full Name
British Virgin Islands
Isle of Man
US Virgin Islands
First Name
Last Name
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other Severe food or insect allergies?
Allergic reactions to medications?
❏
Yes
❏
Yes
❏
No
❏
No
If yes, please list:
No
Year
Year
Year
Year
If yes, please list:
Please list any regularly taken medication(s) including as needed prescription medications.:
Condition(s) or reaction(s) from these medications:
Other conditions or sensitivities
Parent Name
Date
First Name
Last Name
Month
Day
Volunteer's Full Name
First Name
Last Name
Phone Number (main)
Phone Numbrt (Alt)
Area Code
Area Code
Phone Number
E-mail
Best Contact
❏
Phone
7:00am-9:00am
Email
9:00am-11:00am
❏
Monday
❏
Monday
❏
Tuesday
❏
Tuesday
❏
Wednesday
❏
Wednesday
❏
Thursday
❏
Thursday
❏
Friday
❏
Friday
❏
Saturday
❏
Saturday
❏
Sunday
❏
Sunday
11:00am-1:00pm
1:00pm-3:00pm
❏
Monday
❏
Monday
❏
Tuesday
❏
Tuesday
❏
Wednesday
❏
Wednesday
❏
Thursday
❏
Thursday
❏
Friday
❏
Friday
❏
Saturday
❏
Saturday
❏
Sunday
❏
Sunday
3:00pm-5:00pm
❏
Monday
❏
Tuesday
❏
Wednesday
❏
Thursday
❏
Friday
❏
Saturday
❏
Sunday
❏
Food Setup & Cleanup
❏
Monitor Restrooms
❏
Early Camp Vol.(7:00am-9:00am)
❏
Guest Artist Hospitality
❏
Activities Setup and Breakdown
❏
Classroom/Teacher Assistant
❏
Camp Registration
❏
Greeters
Please select your payment option below:
❍ Onsite (Cash, Credit/Debit, Money Order)
❍
Powered by TCPDF (www.tcpdf.org)
❏
Online (via Paypal)*
Phone Number
Year