I hereby enroll my (son) (daughter), First Name Last Name
who's age is and birthdate is in one of the following camp session(s) subject to the conditions of Camp Blue Ridge.

Select One:

PLEASE FILL OUT ALL INFORMATION & FIELDS

Full name of parent or guardian whom child lives with

Home Address City

State Zip

Phone Fax Cell

Father’s Office-Name of Business Address

Phone Cell Email

Mother’s Office-Name of Business Address

Phone Cell Email

Emergency Contact (If parents cannot be reached) Name Phone

Email for Summer Communication

Medical Insurance Company Policy #

Camper Profile

Child's Gender Allergies

Tell us about your Child Activity Interest

SCHOOL AND Current Grade (must be accurate for proper bunking)

Bed selection upper or lower:

Years at Camp Blue Ridge excluding upcoming summer:

You may request that your child be in a cabin with a friend. Please request only 1 since multiple choices may not be granted.

Friend's Name (Friend must request too. It is not always possible to keep requests confidential.)

BY FILLING OUT THIS APPLICATION YOU ARE AGREEING TO ALL TERMS AND CONDITIONS

2022 ENROLLMENT APPLICATION

PLEASE FILL OUT ALL INFORMATION & FIELDS

Camper Profile