Date *

MM

DD

YYYY

Camper's Full Name *

First Name

Last Name

Camper's Date of Birth *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone *

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Emergency Contact Atl. Phone

(###)

###

####

Media Disclosure *

We may periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; public relations and marketing purposes: images printed on brochures, posters, and newsletters, or on Morganton Day School's Website, Facebook Page, and/or other education, or news related publications. Please indicate whether you will allow publication of anonymous photographs of your child.

I Consent

I Do Not Consent

Applications are incomplete and spots are not reserved until payment is received in full. *

I Acknowledge