Youth and Teen Camp (ages 6-21)

Invitation Code*

Please call for code.
Participant's Name:
First Last
Date of Birth:
MM slash DD slash YYYY
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone:
Cell Phone:
Email:
Disability:
Emergency Contact or Parent/Guardian's Name:
First Last
Emergency Contact or Parent/Guardian's Phone:
Emergency Contact or Parent/Guardian's Email:
T-Shirt Size (CHOOSE size from drop down):
Payment Options:*
- Waiver
- Private Pay (grant subsidized cost: $800)
Private Pay Options:
- Check
- Credit Card
A deposit of $250 must be received by the deadline.
Payment Amount:
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
REQUIRED PAPERWORK:
- I will complete information in CampDoc.
- I need help setting up a CampDoc account.
- I am completing all paperwork linked below.
- Please send me a campership application.

days

hours

minutes

seconds

3000 Stonewood Drive, Suite 100WEXFORD, PA 15090 724-934-9600INFO@SBAWP.ORG