Wild Adventure Camp Registration
Please fill out this form and click submit.
Name
*
Birthday
*
Gender
*
Please select one option.
Male
Female
Select Option
Male
Female
Grade Completed by Camp
*
Please select one option.
6
7
8
9
10
11
12
Select Option
6
7
8
9
10
11
12
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Adult Shirt Size
*
Parents Email
*
This address will receive a confirmation email
Student's Email (if applicable)
This address will receive a confirmation email
Home Phone
Emergency Phone Number
*
Other Phone
Father's Name
Mother's Name
$50 Non-refundable deposit can be dropped off to the FBC Office or mailed to FBC 812 Lassen Lane Mt. Shasta, CA 96067
Submit
Description
Please fill out this form and click submit.
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