Name of Person filling out form:
Parent's Name:
Street Address:
City:
State/Zip Code:
Country:
Home Phone:
Parent's Business Phone
     Phone #1:
     Phone #2:
Cell Phone:
Email:

1st Teen's Information

First Name:
Last Name:
DOB:
School Grade: Public:     Private:
Gender: Female:     Male:
Length of Session
  2 wk:   4 wk:   6 wk:   8 wk:   full session:
Budget per week:
Type of Teen Activity
Teen Camp
Cross Country Travel
Academic Enrichment
Language
    French
    Spanish
    Other
Wilderness
Community Service
Worldwide Touring
Semester Program

2nd Teen's Information

First Name:
Last Name:
DOB:
School Grade: Public:     Private:
Gender: Female:     Male:
Length of Session
  2 wk:   4 wk:   6 wk:   8 wk:   full session:
Budget per week:
Type of Teen Activity
Teen Camp
Cross Country Travel
Academic Enrichment
Language
    French
    Spanish
    Other
Wilderness
Community Service
Worldwide Touring
Semester Program

3rd Teen's Information

First Name:
Last Name:
DOB:
School Grade: Public:     Private:
Gender: Female:     Male:
Length of Session
2 wk:   4 wk:   6 wk:   8 wk:   full session:
Budget per week:
Type of Teen Activity
Teen Camp
Cross Country Travel
Academic Enrichment
Language
    French
    Spanish
    Other
Wilderness
Community Service
Worldwide Touring
Semester Program

NOTE: Student Camp & Trip Advisors will keep all information provided as confidential