*  Application For:    Camper    Counselor      * Required Fields
Camper / Counselor *  First *  Last *  Address *  City *  State *  Zip Country *  Phone (H) Phone (C)	*  Gender:  Male    Female   Date of Birth   mm/dd/yyyy *  Age at Camp Grade in Fall    or College Year     Select Weeks 2012  ( * Campers Only):  Week 1 July 08 - 14  Week 2 July 15 - 21  Week 3 July 22 - 28  Week 4 July 29 - Aug 04 Teen Week
*  Email    For all correspondence
*  T Shirt Size:   Youth    Small    Med    Large    Adult    Small    Med    Large
Parents of Camper:    (If same address and phone, mark "Same")
Parent 1 (Father) First Last Address City State Zip Country Phone (H)    Phone (W) Phone (C) Email	Parent 2 (Mother) First Last Address City State Zip Country Phone (H) Phone (W) Phone (C) Email
Emergency Contacts: (If same as above, just mark Relation "Mother" or "Father". Be sure to provide more than one phone number)
Emergency Contact 1 Relation First Last Address City State Zip Country Phone (H) Phone (W) Phone (C) Email	Emergency Contact 2 Relation   e.g. Uncle, Aunt First Last Address City State Zip Country Phone (H) Phone (W) Phone (C) Email
Parish Parish    Location Pastor Phone Email	Health Care Provider Name     Address City State Zip Phone
Medical Notes / Special Concerns:
Transportation Required:    To Camp    From Camp
Transportaion Notes,   Plane / Train / Bus,   Need / Offer Car Pool:

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