Camper Namerequired

Date of birthrequired (mm/dd/yyyy)

Age as of 6/1/2022required

Grade as of 09/01/2022required

Parent or Guardian #1 Namerequired

Parent or Guardian #1 Cellrequired

Parent or Guardian #1 Emailrequired

Parent or Guardian #2 Name

Parent or Guardian #2 Cell

Parent or Guardian #2 Email

Addressrequired

In case of Emergency: Name, Relationship, Cell #required

Physician's Name, Tel # *

Health/physical issues, special needs, allergies

T-shirt sizerequired

PLEASE NOTE: Applications are accepted on a first-come, first-serve basis, with the understanding that preference will be given to campers registering for the full two-week program. We urge you to register as soon as possible as we have had groups close out in the past. Thank you.

FOR PAYMENT, PLEASE CONTACT ROBYN GAINES AT rgaines@cgps.org.