Lehigh Valley Keepers Camp

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Registration

Please fill out this form completely to register for camp.

Full Name
First
Last
Address
Street Address
Address 2
City
State / Province / Region
Postal / Zip Code
Phone xxx xxx xxxx
Email
Emergency Contact/Phone
Medical Insurance Company
Policy #
Other Medical Needs Staff Should know

Payment Options
Send a Check (Make Payable to Sam Bishop)
Pay Online

Paypal will show as Sam Bishop