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

* 2. Parent/Guardian Information

* 3. Emergency Contact Information #1

* 4. Emergency Contact Information #2

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

* 6. Does your camper have any allergies?

* 7. Please list any Camper medications and other pertinent medical information

* 8. Please list any adults that have permission to pick up your camper from camp.

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

* 10. I would like to pay the $225 Winter Weekend Camper fee by ______

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