2024 MLBC High School 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
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
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 High School Camp
$235
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)
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)
None ($0)
5 ($5)
10 ($10)
15 ($15)
20 ($20)
25 ($25)
Amount
Medical Release
2024 Medical Release
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Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Please fill out a separate registration form for each camper
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