Camp registration

Campers Name *

First

Last

Birthday *

mm/dd/yyyy

Camp Option

Phone Number (home)

Phone Number (cell)

Email *

Home Address

(Street, City, ST, Zip)

How did you hear about us?

Known Allergies

Allergic to Bees

Year of Last Tetnus Shot

Any injuries we should be aware of?

List current medications and conditions for physical or psychological conditions:

Physician name, address and telephone number:

Name of 2 Emergency Contacts, Relationship, Phone Number:

6899 Route 100B
Moretown, VT 05660
802.223.1903