2024 MLBC Day Camp Registration

Please fill out a separate registration form for each camper

Camper Name

*

Gender

*

Please select one option.

Male Female

Phone

*

Email

*

This address will receive a confirmation email

Address

*

Grade Next Fall

*

Date of Birth

*

Parent/Guardian Name (First and Last)

*

Parent/Guardian Relationship

*

Parent/Guardian Phone (if Different)

*

Secondary Emergency Contact Name (First and Last)

*

Secondary Emergency Contact Relationship

*

Secondary Emergency Contact Phone Number

*

Any Food Allergies or Medical Problems we should know about

*

Requested Cabinmates

Comments

Payment Day Camp $109

T-Shirt

None (0) Youth XS ($10) Youth S ($10) Youth M ($10) Youth L ($10) Youth XL ($10) Adult XS ($10) Adult S ($10) Adult M ($10) Adult L ($10) Adult XL ($10) Adult XXL ($12) Adult XXXL ($12)

Amount

Snaque Shoppe Money

None ($0) 5 ($5) 10 ($10) 15 ($15) 20 ($20) 25 ($25)

Amount

Medical Release

2024 Medical Release<< Please Fill out this form!

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Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out a separate registration form for each camper

Please Fix the Following

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