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Camper Registration Form
Contact Information
Family/Surname:
*
Given Name:
*
The given name of the parent or guardian of the camper(s).
Address:
*
E-mail:
*
Primary Contact Number:
*
Secondary Contact Number:
Fax Number:
Camp Preferences
Period Interested In:
*
This Upcoming Summer
The Following Summer
Type(s) of Camp Interested In:
*
Traditional Camp
Sports Camp
Art Camp
Weight Loss Camp
Korea Camp
Learning Tours
Location Preference:
*
East Coast
West Coast
No Preference
Attending Child #1
Name:
*
Age:
*
Birthday:
*
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
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Year
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Grade:
*
As of Fall 2011
Interests/Needs:
Previous Camping Experience:
*
Attending Child #2 (click to expand)
Name:
Age:
Birthday:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
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Year
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Grade:
As of Fall 2011
Interests/Needs:
Previous Camping Experience:
Attending Child #3 (click to expand)
Name:
Age:
Birthday:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Grade:
As of Fall 2011
Interests/Needs:
Previous Camping Experience:
How did you hear about Stateside Adventures?:
*
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