Join us for this annual tradition - Welcoming campers ages 11-13 and 14-17!

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* 1. Camper Information (please complete a new application for each camper)

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* 2. Parent/Guardian Information

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* 3. Emergency Contact Information #1

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* 4. Emergency Contact Information #2

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* 5. When was your last summer as a Quinipet camper?

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* 6. Does your camper have any dietary restrictions? If yes, please explain:

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* 7. Does your camper have any allergies? If yes, please explain:

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* 8. Please list any camper medications and other pertinent medical information:

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* 9. Please list any adults that have permission to pick up your camper:

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* 10. I understand that I must submit the separate "Winter Weekend Permission Form" with my signature via email or fax by Friday, 12/21/18.

The Permission Form PDF is available for download at Quinipet.org
(email: quinipet@nyac.com / fax: (631) 749-3403)

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* 11. Quinipet Camp & Retreat Center ________ have permission to use photographs of my camper in any promotional material and social media postings.

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* 12. Payment is due by Friday, 12/21/18. I would like to pay the $250 Winter Weekend Camper fee by:

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