If you have a PayPal account, choose ‘PayPal Checkout.’ Otherwise, select ‘Debit/Credit Card’ – no PayPal account needed.
First name *
Last name *
Country / Region (optional)
Street address *
City *
ZIP *
State * Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)
Phone *
Email address *
Since the participant is not currently enrolled at The Gregory School, we need to have the following emergency and medical information on file for camp participation.
Emergency Contact Name: *
Emergency Contact Phone: *
Parent/Guardian Contact Email: *
Physician’s Name: *
Physician’s Office Phone: *
Preferred Hospital *
Medical Insurance provider *
Medical Insurance Policy # *
Camper Allergies or Medical Conditions *
Student First Name *
Student Last Name *
Student Grade Level * 56789101112
Order notes (optional)