Register Your Child "*" indicates required fields Camp Information- Select Youth Week (Sun-Thurs) attending* IBEW Local 47 - June 28th - July 2nd Teamsters JC42 - July 6th - 10th Teamsters Local 1932 - July 13th - 17th IBEW Local 47 - July 20th - 24th Camper Registration Form This form must be completely filled out and signed by parent or guardian and returned to Youth HelpersChilds Name* First Last Date of Birth* MM slash DD slash YYYY Age*7891011121314Grade (going into)*Gender* Male Female Shirt SizeYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult XXLAddress* 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 Preferred cabin mates (if any) Cabin mates ARE NOT guaranteed. Campers are divided into cabins by age, gender and enrollement.The following information is requested to help our counselors get to know a little bit about your child before he/she arrives at camp. The information will be kept confidential and is only shared with the counselors who will be working directly with your child. Please be thorough in order to help us provide your child with the best camp experience possible. Does the camper go by a nickname?Has the camper attended camp before?* Yes No If yes, what type of camp (day or overnight) and for how many years?Is there anything else you could tell us about the camper that would be helpful for their counselors to know?* Yes No If Yes, what other information would you add?Parent or Guardian InformationParent / Guardian Name* First Last 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 Cell Phone*Home PhoneEmail* If parent or guardian is unavailable in an emergency, notify:Name*Relationship*Phone*Second PhoneParent’s Signature*Financial InformationPayment options*Pay full amountCoupon Camper Cost: Price: Total • Union Affiliation if applicable for special Camp WeeksMember Name First Last LocalCompanyPlease Read the Liability Waiver and Check the box below.* I agree to the Liability and Waiver Agreement Terms Please Read the Camp Rules and regulations and Check the box below.* I agree to the Camp Rules and Regulations To finalize registration, please sign your name below and click SUBMITSignature*NameThis field is for validation purposes and should be left unchanged.
