PERSONAL INFORMATION:
Enter information about each group of campers attending for the same duration (entire week or part of the week),
including parents/adults. Children under 5, including babies, are free, but please include
their registration information with rest of family.
Full week and Daily Rate pricing will be displayed on the next page based on information entered below.
FIRST NAME LAST NAME GENDER GRADE
THIS FALL*
AGE AT
CAMP TIME
BIRTHDAY
(mm/dd/yy)
CAMPER ONE
CAMPER TWO
CAMPER THREE
CAMPER FOUR
CAMPER FIVE
CAMPER SIX
* Indicate the camper's school grade as of this fall (such as 1, 2, 3, . . 12).
For children under 5, use the PS code.
For college level use: CFR = College Freshman, CSO = College Sophomore,
CJR = College Junior, CSN = College Senior, GS = Graduate Student.
Parents and Adults in general should use the code PG (Post-Graduate).


CAMP INFORMATION:
One t-shirt per camper is included in the registration fee.

T-SHIRT SIZE? SHORT OR
LONG SLEEVE?
ATTENDED
MYC BEFORE?
WHAT
YEAR?
WHO WAS YOUR
COUNSELOR?
CAMPER ONE Short-sleeve   Long-sleeve Yes   No
CAMPER TWO Short-sleeve   Long-sleeve Yes   No
CAMPER THREE Short-sleeve   Long-sleeve Yes   No
CAMPER FOUR Short-sleeve   Long-sleeve Yes   No
CAMPER FIVE Short-sleeve   Long-sleeve Yes   No
CAMPER SIX Short-sleeve   Long-sleeve Yes   No

MEDICAL INFORMATION:
Please provide the following information for each camper listed above.

DOCTOR'S NAME
AND PHONE
MEDICAL INSURANCE
COMPANY AND POLICY #
KNOWN MEDICAL
CONDITIONS
CAMPER ONE
CAMPER TWO
CAMPER THREE
CAMPER FOUR
CAMPER FIVE
CAMPER SIX

FAMILY CONTACT INFORMATION:
Please provide the following information for the parents or responsible adults of the family of the camper(s) listed above.

Father’s Name:     Attending Camp? Yes   No
Father’s Age:     Occupation:  
Mother's Name:     Attending Camp? Yes   No
Mother’s Age:     Occupation:  
Address:   
City:     State:     Zip:   
Phone:     Mobile:    
In case of emergency contact:   at  
Parent or adult camper e-mail address:   (Required! We need this to contact you!)
Alternate e-mail address: