Summer Camp Application Step 1 of 7 14% Parent Contact DetailsParent Name(Required) First Last Parent Email(Required) Enter Email Confirm Email Parent Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How did you hear about camp?(Required)Social MediaGoogleWord of MouthRefer a FriendPast ParticipantOther Participant DetailsParticipant Name(Required) First Last Gender(Required)MaleFemalePrefer Not to AnswerDate of Birth(Required) MM slash DD slash YYYY Shirt Size(Required)Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeMedical(Required)Please detail any current medical needs, allergies or injuries that effect the participantPlease detail any current medical needs, allergies or injuries that effect the participant Camp Selection Jr. Circuit Program Descriptions Academy Program Descriptions Camp Program(Required) Jr. Circuit Academy JR. CIRCUIT — Red, Orange, Green, Future Champs | ACADEMY — Super Squad, HP Dev, HP Jr. Circuit Program(Required)RedOrangeGreenFuture ChampsJr. Circuit Full Day Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Junior Circuit Half-Day Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Total Academy Program(Required)Super SquadHP DevHPAcademy Full Day Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Academy Half-Day Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Total Consent(Required) I have signed the agreements above Billing Address(Required) Same as previous Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Coupon Total Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name
