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*	First Name:

*	Last Name:

*	Email Address:

	Phone:

*	Program Interested In:

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Summer Camps start in:

Summer Camps are here!

General Information

Camper Name

Gender

Male
Female

Age

Date of Birth (mm/dd/yyyy)

Entering Grade

Address

Parent/Guardian Name(s)

Phone #

E-mail (parents)

This camper has food allergies.

Yes *You must list allergies below.
No

Please list any food allergies this camper has. The Kitchen Manager may call you for further clarification. Food allergies MUST be specified before arrival or we cannot guarantee accommodation.

Are there any physical limitations preventing full participation in the camp program?

Physical limitations?

Yes *List limitations below.
No

*If "yes," please provide an explanation here.

Program Selection

Please check each week that this camper will attend.

Adventure Camp (Boys & girls Entering grades 1-3)

June 20-23 *(Boys are FULL)

Boy's Camp (For boys entering grades 3-11)

Boys Camp

Boys Week 1 Survivor Week (June 23-30)
Boys Week 2 Medieval Week (June 30-July 7) *(Grades 6-8 FULL)
Boys Week 3 Explorer Week (July 7-14)

Girls Camp (For girls entering grades 3-11)

Girls weeks

Girls Week 1 Survivor Week (July 14-21) *(THIS WEEK IS FULL)
Girls Week 2 Medieval Week (July 21-28)
Girls Week 3 Explorer Week (July 28-August 4) *(Grades 6-8 FULL)

Wilderness Adventure Trips (Ages 14-18)

We are sorry, but the New River Gorge Experience (June 23-30) is full!

Online registration for the Adirondack Adventure (July 21-28) is closed. Please call the office at 570-998-2151 if interested.

Optional (but helpful) Information

Church you attend

City

Bunk Request (only one)

I was referred by

I am a new camper

I would like information on

Camper Scholarships
Time Payments
Homeschool Family Camp
Classic Family Camp
Homeschool Classes (year round)

How did you hear about us?

Please register my child for the week(s) selected. I give permission for him/her to participate fully in all camp activities and to be included in any photographs and/or video productions

Click Me to Edit

I agree

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Please enter the characters above exactly as they appear before clicking "submit".

*If you register for a week that is FULL, you will be placed on a waiting list. You do not have to submit a deposit if you are on a waiting list.

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