Summer 2023 Youth LAST HURRAH Camp Registration – Carlisle

Last Hoorah Camp Registration 2023

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Participant Name(Required)

First Middle Last

Gender

Age(Required)

Grade(Required)

School(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Caregiver/Guardian Name(Required)

First Middle Last

Home Phone(Required)

Cell Phone

Work Phone

Caregiver Email(Required)

Emergency Contact Information

If you cannot be reached, please provide two names of local persons to contact in case of emergency.

Name(Required)

First Last

Relationship to Participant(Required)

Phone(Required)

Name(Required)

First Last

Relationship to Participant(Required)

Phone(Required)

Allergies/Other Medical Conditions

Last Hurrah Camp Registration (Required)

Price: $150.00

Total

Credit Card

Cardholder Name

Card Details