If you are human, leave this field blank. 1. Camper Information First Name * Surname * Street Address * City/Town * Province/State * Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ---USA--- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ---------------- Other, not listed Gender * Male Female Postal Code / ZIP * Date of Birth (YYYY-MM-DD) * Age * Please note that the age range for Junior Camp is 7-11. If you're child will not fall within this bracket by camp and you want them to attend, please contact us before completing the application. Email Address Billing Email Address T-Shirt Size (Please select a size) * Youth XS Youth S Youth M Youth L Youth XL Grade Level (Fall 2019) * JK SK 1 2 3 4 5 6 7 8 9 10 11 12 College/University Other Church Affiliation * GCI Ottawa GCI Toronto GCI Montreal TMH Ottawa Parent/Guardian Full Name * Parent/Guardian Home Phone * Parent/Guardian Cell Phone * Parent/Guardian E-Mail * Emergency Contact 1 Full Name * Emergency Contact 1 Home Phone * Emergency Contact 1 Cell Phone * Emergency Contact 1 E-Mail * Emergency Contact 2 Full Name * Emergency Contact 2 Home Phone * Emergency Contact 2 Cell Phone * Emergency Contact 2 E-Mail * Dorm Mate or other requests (two names max.)