Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Program interests

Program Interests?

Swimming (available June-August)

Canoeing at Jenks Lake (available June-August)

Archery

Group games/ Team-Building

Climbing Wall (30 ft with ropes and harnesses)

Campfires

Rest and Relaxation

Hiking

Snow play (November-March weather permitting)

Indicate first choice for arrival date.

MM

DD

YYYY

Indicate first choice for departure date.

MM

DD

YYYY

Indicate second choice for arrival date.

MM

DD

YYYY

Indicate second choice for departure date.

MM

DD

YYYY