First Name:

Last Name:

E-Mail:

Phone:

Street:

City:

State or province:

Zip:

Additional attendees? None 1 2 3 4 5

Is the child Male or Female?
male
female

What is the child's birthday?

What week will the child be attending Sea Turtle Camp?

Select One
June 7th-11th (10-12 years)
June 14th-18 (6-9 years)
June 21st-June 25th (10-12 years)
June 28-July 2nd (6-9 years)

Does your child have any special needs?

Parent/Guardian Name

Relationship to child

Is there a local address where you are staying?

Emergency Contact / Relationship to Child

Phone/Call/Alternate Phone of Emergency Contact

How did you hear about Sea Turtle Camp?

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