Boy's Name *

First Name

Last Name

Boy's Birth Date *

MM

DD

YYYY

Parent's Name *

First Name

Last Name

Parent's Mobile Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

My son has serious allergies to food, insects, etc. *

Yes

No

My son has significant dietary requirements that require special foods, such as Gluten Free. *

Yes

No

My son is being treated for physical illnesses or other medical conditions that could be hazardous in an outdoor camp. *

Yes

No

My son is being treated for psychological trauma or other emotional conditions that could be triggered by challenging exercises designed to help him grow. *

Yes

No