Intern Application

Name:


First	Last

Preferred Name (if different):

Address:

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Home Phone:

-
Area Code	Phone Number

Cell Phone:

-
Area Code	Phone Number

E-mail:

Best way to contact you: *

How old will you be at the time of camp?

T-shirt Size

Emergency Contact's Name:


First	Last

EC Relationship:

EC Home Phone:

-
Area Code	Phone Number

EC Work Phone:

-
Area Code	Phone Number

EC Cell Phone:

-
Area Code	Phone Number

Dietary Restrictions:

Do you have any food allergies or medical information we should know about?