Camper Name: __________________ Camp STORM Participation Registration Form                Age: _____

Camper:

First ______________________________________________ Middle _________________ Last ____________________________ _______

School Name ______________________________________________________ Grade _______Birth date _________/_____/___________

Street Address_____________________________________________________________________________________________________

Town/City ____________________________________________________________________ State ______ Zip code _________________

Parent/Guardian - Contact Information

First____________________________________________Last______________________________________________________________

Street Address_____________________________________________________________________________________________________

Town/City ______________________________________________________________________ State __________Zip Code ____________

Home Phone _____________________________Work Phone ____________________________Cell ________________________________

E-mail ____________________________________________________E-mail___________________________________________________

Emergency Contact Information

Emergency Contact #1

First Name ___________________ Last Name ___________________ Home Phone ________________ Work Phone _________________

Cell Phone ____________________ Email ______________________________________ Relation to child __________________________

Emergency Contact #2

First Name ___________________ Last Name ___________________ Home Phone ________________ Work Phone ________________

Cell Phone ___________________ Email ________________________________________ Relation to child ________________________

Weekend Warriors- $ 225.00 (Friday – Sunday) $ 100.00 due with registration, $ 125.00 due weeks prior to session.

                                (see Spring/Fall calendars for Weekend Warriors scheduled weekends)

Sunday, June 9 – 14, 2019                      Sunday, June 16 – 21, 2019                          Sunday, June 23 – 28, 2019

Sunday, July 7 – 12, 2019                       Sunday, July 14 – 19, 2019                            Sunday, July 21 – 26, 2019