Camper's Full Name (required)

Camper's Birthday DD/MM/YYYY (required)

Camper's Grade in School (required)

Camper's Ethnicity (optional)

Camper's Sex:
 Male Female

Address (required)

Adress 2

City (required)

State
AlabamaAlaskaArizona ArkansasCaliforniaColorado ConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaine MarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraska NevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth Dakota OhioOklahomaOregonPennsylvania Rhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsin Wyoming

Zip Code (required)

Phone Number (required)

Camper's Church, and its Location

Parent or Guardian's Name (required)

Parent or Guardian's Work Phone(required)

Parent or Guardian's Cell Phone (required)

Parent or Guardian's Email (required)

How did you hear about us?

Name of Person Lost

Cause of Death

Relationship to Child

How long ago?

How many adults attending camp?

Optional:
 Request a Scolarship

Limited scholarships for Camp Carey are available. Scholarships will be awarded based on need as assessed by Camp Carey staff. All decisions are final.

Additional Information or Comments

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