Camper Application

When all fields have been completed, click SUBMIT FORM to send camp application.

Camper Information

First Name

Last Name

Camp Choice

Camp I: June 20 – 26, entering grade 5 or 6
Camp II: June 27 – July 3, entering grade 7 or 8

Date of Birth (i.e. MM/DD/YYYY)

Weight (approx. in lbs.)

Height (approx. feet & inches)
Please do not enter apostrophes or quotation marks in this height field. Instead, please use ft and in. Therefore, if your son is 5'8", please enter 5 ft 8 in.

School (currently attending)

Grade (entering next fall)

Musical Instruments

Parent / Guardian Information

Father's Name

Father's Phone Number

Father's Email Address
If you have only one email address in the family, please enter it here. We will confirm your application using this email only. Thank you.

Mother's Name

Mother's Phone Number

Mother's Email Address

Medical & Photo

Insurance Company

Group Number

Policy Number

Insurance Company Phone Number

Health Information (Any pertinent health information, allergies, medications, etc.)

Home Address and Phone Number

Phone Number

Street Address

City

State

Zip

For first-time applicants: From whom did you hear about the YSI camp?

Electronic Signature (enter YES to accept medical & photo release)

As the parent/guardian of the boy identified on this application, I hereby delegate authority to the Directors of the Summer Leadership Camp to arrange whatever medical treatment they deem necessary for him during his stay at the camp.

Also, I hereby authorize and consent to the use and reproduction by YSI staff or an authorized agent or assignee of any and all photographs taken of my son for the purpose of promoting YSI programs, without any compensation to me. All film, together with any prints, shall constitute property of YSI, solely and completely.

Enter "yes" to confirm both and your application will be complete. If you type "no", then we will have to discuss other circumstances that can be agreed to for your son to attend the camp and the application will not be complete until we can reach an agreement.

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Youth Service International

Camper Application

Camper Information

Parent / Guardian Information

Medical & Photo

Home Address and Phone Number