Front Rush

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General

Camper First Name *

*Please enter valid Camper First Name

Camper Last Name *

*Please enter valid Camper Last Name

Parent/Guardian Name *

*Please enter valid Parent/Guardian Name

Parent/Guardian Email Address *

*Please enter valid Parent/Guardian Email Address

Preferred Phone Number *

Home

Cell

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Phone Number *

*Please enter valid number

Address 1 *

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Address 2

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City *

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State *

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Zip *

*Please enter valid Zip

Date of Birth *

Open the calendar popup.

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Profile Image

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Grade (Fall ’18) *

*Please enter valid Grade (Fall ’18)

Age at Time of Camp *

*Please enter valid Age at Time of Camp

School Name *

*Please enter valid School Name

Roommate Preference (please only list one)

*Please enter valid Roommate Preference (please only list one)

Club Team

*Please enter valid Club Team

Any medical conditions of which we should be aware *

*Please enter valid Any medical conditions of which we should be aware

T-Shirt Size *

*Please enter valid T-Shirt Size

Camp Choice *

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Insurance Company *

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Insurance Policy Number *

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Emergency Contact Name *

*Please enter valid Emergency Contact Name

Emergency Contact Phone Number *

*Please enter valid Emergency Contact Phone Number

Note to Camp Director

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