Name of School *

First Name

Last Name

School Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School Phone Number *

(###)

###

####

Group Leader *

First Name

Last Name

Group Leader Phone Number *

(###)

###

####

Principal Name *

First Name

Last Name

Principal Phone Number *

(###)

###

####

Your Time at Camp *

Please choose the type of program you would like as well as your top 3 choices for encampment dates. Based on program, availability, and your group size, we will do our best to accommodate your group's needs.

MM

DD

YYYY

*

MM

DD

YYYY

*

MM

DD

YYYY

Student grade level(s) *

2

3

4

5

6

Would you like the store available to your students during their lunch or free time? *

Yes

No