Camp signup, Version 2, 10/25/200707

Camp Request & Registration

Parent or Adult Name
First Name Last Name

Childs Name
First Name Last Name Date of Birth

Address

City State ZIP Code

E-mail address

Daytime Telephone Evening Telephone Best Time to contact:

Contact Preferred method of Contacting:

I am requesting information for Age
Select Camp: Select Age Level

Who Referred You: Referred by Other:

Select Payment Type
Credit Card Number Expiration Date

Comments

Signature_____________________________________________________________________________________

Print this when complete and mail to OWLS with payment.
Address on form or call OWLS at 252.240.1200 for help. Thank You.