Camper’s Name

Male

Female

Name(s) of Parents or Guardians

Address (including Postal Code)

Phone (Home)

Phone (Work)

Date of Birth & Age

School Grade Completed

Health Care #

* Home Church

* Clergy

Can the child swim? Last level completed

Name & Date of the Camp wishing to attend

How did you hear about Camp MacLeod?

_ Friend  _Poster Ad

_ Church _ Other