MS Camp Registration

1. Name *

2. Address, City, ST/ZIP *

3. School and Grade (completed 5th & up to 8th grade) *

4. Gender * Female Male

5. Birthday (must be 11 yrs old by August 1) *

6. Food Restrictions or Allergies *

7. Student's Email *

8. Student's Phone *

9. Emergency Contact Person / Parent *

10. Phone # Emergency Contact Person

11. Parent's Email *

12. Parent's Phone *

13. Please check box if a parent of the student is currently incarcerated to receive information about a potential scholarship. *

• yes
• no

14. Check All That Apply then click (Submit to Pay) *

• Yes, I understand this is a non-refundable but transferable deposit
• Reserve my spot $50 -by March 15th
• This is my 2nd Deposit $50 -by May 10th
• I am paying in full to get the Early-Bird Discount for Camp of $225 -by May 10th
• Add this amount to my camp balance