Check if this is an update to a record you already submitted:

if checked, you must still complete the entire form

Name *

only young men register this year

First Name

Last Name

Birth date *

MM

DD

YYYY

Days Coming to Camp *

Please commit to attend the days you have signed up for. We will plan for you to be in attendance . To get the most out of camp, participating in all three days is best. Please make a special effort to be with us on Friday June 21, as we have a special fireside planned.

Wednesday (June 19)

Thursday (June 20)

Friday (June 21)

Saturday (morning return home)

T-shirt size *

Small

Medium

Large

X Large

2X Large

Phone number

(###)

###

####

Emergency telephone *

(###)

###

####

Swimming ability *

Strong

Moderate

Weak

Parent/guardian electronic signature and date *

TO BE COMPLETED BY A PARENT OR GUARDIAN: I have reviewed and approve the completed "Permission and Medical Release Form" along with this registration form.

Yes

Date *

MM

DD

YYYY