Pre-registration Form
CAMPER INFORMATION
Name__________________________________
Age_________ Date of Birth______________
Address________________________________
City____________________ Zip ____________
Phone__________________________________
Grade entering in September 2012 _______
Check one
Session 1 ___
Session 2 ___
Session 3 ___
Extended Care: Before ___ After ___
PARENT/GUARDIAN INFO
Name:__________________________________
Address:________________________________
City ___________________Zip _____________
Phone (home)___________________________
Cell ______________ Work________________
Email: _______________________________
I will help with Field Trips.
Y ___ N ___