First Name Middle Initial Last Name
Street
City State Zip
Home Phone Email
Do you work for an area camp? Yes No If yes, which camp?
Are you current in CPR? Yes No
Please check the courses that you are registering for below:
Half of the course tuition is due upon registration and the other half will be due the 30 days before the course. A nonrefundable 25% fee will be charged if the participant is to cancel within 30 days of the start date of any course(s) registered for. Lodging and meals are included in tuition.
Signature Type your name.