Little Pioneer Camp Little Ballers CampRegistration Form1Registration2PaymentI am registering for:*Camp 1 – June 10 – 13Camp 2 – July 8 – 11Days attending:*All four days – $120I can only make a few days – $30 per dayI can attend these days:* Monday – $35 Tuesday – $35 Wednesday – $35 Thursday – $35Total Price Price: $0.00 How did you learn about the camp?*CAMPER INFORMATIONPlease complete the following information about the camper you are registering.Name* First Last Date of Birth* MM slash DD slash YYYY Age*Grade*High School Graduation Year*Height*Weight*T-Shirt Size*Youth XLSmallMediumLargeXLPARENT/GUARDIAN INFORMATIONPlease complete the following information about the parent/guardian of the camper you are registering.Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EMERGENCY CONTACT INFORMATIONWho should we contact in the event of an emergency?Name* First Last Phone*LIABILITY RELEASE AND WAIVER/ PARENTAL CONSENT FORM & MEDICAL RELEASE* Do you accept the above terms?Total $0.00 Credit CardNameThis field is for validation purposes and should be left unchanged.
