Skin & Bones Camp (N/NE Portland) Registration Student's Full Name:*Student's Nick Name:Parent or Gaurdian's Name*Parent or Gaurdian #2 NameParent or Gaurdian #1 E-mail Address Enter Email Confirm Email Parent or Gaurdian #2 E-mail Address Enter Email Confirm Email Parent/Gaurdian #1 PhoneParent/Gaurdian #2 PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student's Date of Birth*Student's Age*Known Medical Conditions (i.e. allergies, medications, ADD, etc.):*Emergency Contact Name (OTHER THAN PARENT)*Relationship to Student*Emergency Phone #*List names of people authorized to pick up your child:*How did you hear about us?*What is your child's experience in nature?*Captcha Δ
Skin & Bones Camp (N/NE Portland) Registration