Camper's Full Name *

(note if they go by a different name)

First Name

Last Name

Which week(s) of camp are you registering this child for? *

June 9-13 Nature Camp

June 30-July 4 History Camp

Camper's Birthday *

MM

DD

YYYY

Guardian's Full Name *

First Name

Last Name

Guardian Primary Phone *

(###)

###

####

Guardian Secondary Phone

(###)

###

####

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Emergency Contact Name *

First Name

Last Name

Additional Emergency Contact Primary Phone *

(###)

###

####

Additional Emergency Contact Secondary Phone

(###)

###

####

Would your camper need or benefit from daily shuttle transportation from Pulaski to Wolf Gap and back?

If a sufficient number of campers require transportation from PULASKI we will arrange a free camp shuttle.

Yes

No

Camp fills up quickly, but we keep a waiting list in case a registered camper has to change their plans. Do you want to be put on the waiting list? *

Put us on the waiting list.

Don't put us on the waiting list.