Name* First Last Gender Male FemaleBirthday* Month Day YearCurrent Grade*School Attending*Does your child have any allergies?* Yes NoPlease List All Allergies*Does your child require any special accommodations?* Yes NoWhat 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 NameEmergency 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
