SixTwelve Camp Enrollment Form

Student Name *
Student Name
Birth Date *
Birth Date
Primary Address *
Primary Address
Secondary Address (if applicable)
Secondary Address (if applicable)
Parent Name *
Parent Name
Parent Phone *
Parent Phone
Second Guardian Name
Second Guardian Name
Second Guardian Phone
Second Guardian Phone
Allowed to pick up student? *
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Today's Date *
Today's Date