Name of Parent or Guardian Completing This Form *
Name of Parent or Guardian Completing This Form
Address *
Address
Home Phone
Home Phone
Primary Cell Phone *
Primary Cell Phone
Secondary Cell Phone
Secondary Cell Phone
Marital Status *
Are you:
Child's Name *
Child's Name
Grade Completed *
After this current school year, what grade will your child have completed?
Date of Birth *
Date of Birth
Gender *
Has your child ever attended a Pine Cove camp before? *