Camper's Name
DOB
Age
Preferred Position
Address
City
State
Zip
Home Phone
Email
Father/Gaurdian Name
Cell Phone
Work Phone
Mother/Gaurdian Name
Cell Phone
Work Phone
Parental Status
[Choose One]
Single
Married
Divorced
Separated
Single
Emergency Contact
Relationship to Camper
Phone Number 1
Work Phone
How did you hear about us?
Will your child be attending NJY Camp this summer?
[ ]
Yes
No
If so, which session
[Choose One]
Session 1 - Aug 17th-22nd
Session 2 - Aug 24th-29th
BBBA T-shirt
[ ]
1
2
3
4
5
6
7
8
9
10
BBBA Cap
[ ]
1
2
3
4
5
6
7
8
9
10
Summer Highlight DVD
[ ]
1
2
3
4
5
6
7
8
9
10
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