Wild Adventure Camp Registration 2019
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)
Optional
This address will receive a confirmation email
Home Phone
Optional
Emergency Phone Number
Other Phone
Optional
Father's Name
Optional
Mother's Name
Optional
$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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