Winter Break Camp Registration Winter Break Camp (Dec 18-22) Registration Student's Full Name:* Student's Nick Name: Parent or Gaurdian's Name* Parent or Gaurdian #2 Name Parent or Gaurdian #1 E-mail Address Enter Email Confirm Email Parent or Gaurdian #2 E-mail Address Enter Email Confirm Email Parent/Gaurdian #1 PhoneParent/Gaurdian #2 PhoneAddress* 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 Student's Date of Birth* Student's Age* Known Medical Conditions (i.e. allergies, medications, ADD, etc.):*Emergency Contact Name (must not be parent)* Relationship to Student* Emergency Phone #* List names of people authorized to pick up your child:*How did you hear about us?*What is your child's experience in nature?*Captcha Δ
Winter Break Camp Registration
Winter Break Camp (Dec 18-22) Registration