CAMP GEMS APPLICATION
First Name
__________________________________
Age ______________________________
Last Name
__________________________________
Birthdate
_________________________
Campers preferred Name (to be used on name tag):
________________________________________
Street Address
_______________________________
Phone (Day)
______________________
Address (Apt #) _______________________________
Phone (Eve)
______________________
City
________________________________________
State: _______ Zip Code ____________
Email: _______________________________________
School Name _________________________________
Grade in fall ’12
____________________
Special Dietary Needs
_______________________________________________________________
What is your favorite subject this year?
__________________________________________________
Did you participate in a Science Fair this year?
____________________________________________
If so, please describe your project:
______________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
What experience have you had with computers?
___________________________________________
If you have a computer in your
home, what kind?
__________________________________________
Please list extra curricular school, community and
church activities you participated in this year (e.g.
student council, music groups, patrol, etc.)
_______________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
What do you like to do in your spare time? (hobbies, etc.) ____________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
T-shirt Size (Adult): S
M L
XL
XXL
CAMP APPLICATION DEADLINE: June 1, 2012
FEE: $295
which includes all meals, housing, instructional material, recreational
activities, and a T-shirt.
Please make checks payable to:
Mail Form and Check to:
Laurie Laird