All Fields Are Required
Camper Information
Last Name
First Name
Middle Initial
Male
Female
Birth date:
Age as of June 1st
In September :
School
Grade
Shirt Size
Season
Home Information
Street
City
State Zip Code
Phone and area code
Emergency Phone
Request for Placement - Subject to director's
approval. Requests to be with specific counselors cannot be honored.
Transportation Information (Please understand
that it is virtually impossible to honor special transportation requests.)
Name of Development of Community such as Abidale, Richboro Farms, Tannerie
Run.
Main streets or intersections nearest home.
Landmarks
Describe any problems cars or buses may encounter (cul
de sac, etc.)
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