* Camper First Name :

* Camper Last Name :

* Parent First Name :

* Parent Last Name :

* Home Address :

Apt. or Ste :

* City :

* State : select state AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of Columbiafedf78FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUS Virgin IslandUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

* Zip :

Home phone : -- --

* Cell phone : -- --

* Email Address :

* Verify Email Address :

* Camper age (12-18 yrs of age) : select 12 13 14 15 16 17 18

* Gender/Sex : Female

*Will Be Staying Overnight? : Yes NO

* How Many Years Played? : select 123456789101112131415161718

*Attending Cook-Out On Last Day? : Yes NO

*Do you need airport transportation ? : Yes NO

**Do you want to make FULL PAYMENT or just your DEPOSIT of $250 at this time? : FULL PAYMENT DEPOSIT ONLY (If not canceled by May 25th, 2012 there will be no refunds)

* How did you hear about the camp? ---Select--- Internet ad University Website Word of Mouth Other

 

*Please download and save Camp Health Form and fill it out and bring to the camp with you please.