Camp Shape (Form) Step 1 of 4 25% Camper InformationName(Required) First Last Gender(Required)-Select-MaleFemalePrefer not to sayDate of Birth Month Day Year GradeHome PhoneCell PhoneCamper's Email Height (ft)(Required)Height (inch)(Required)Weight (lbs)(Required)How did you first learn about us?-Select-Internet Sponsored AdInternet Search ResultsCamp Shane BlogMagazine AdTelevision AdReferral ServiceFriendOtherWas A Relative/Family Member A Camp Shape Camper or Staff Alumni? Yes No Name of Relation First Last Parent/Guardian Information 1Name(Required) First Last Relationship(Required)-Select-MotherFatherSpouseChildSiblingOther RelativeFriendOtherIs your address the same as the camper? Yes No Cell Phone(Required)Home Phone(Required)Email(Required) Enter Email Confirm Email Employer Work Phone Health Insurance InformationPolicy Holder Name First Last Health Insurance Company Group NumberInsurance ID NumberRX Policy NumberPolicy Holder's Birth Date Month Day Year Employer's Name Insurance Company's Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Session 1 - 6 WeeksSession 1 - 6 Weeks $6,735.00 Please Check Any Session You Would Like To Attend June 24th - July 8th Session 2 - 4 WeeksSession 2 - 4 Weeks $5,580.00 Please Check Any Session You Would Like To Attend July 8th - July 22nd Session 3 - 2 WeeksSession 3 - 2 Weeks $4,005.00 Please Check Any Session You Would Like To Attend July 22nd - August 5th You want to reserve your spot? Yes No Amount(Required) Total Credit CardCard Details Cardholder Name