ReFuel Camp Registration


Student Name *
Student Name
Gender *
Home Address
Home Address
Date of Birth *
Date of Birth
Friend(s) you would like to be in a group with:
Student Phone
Student Phone
Student Phone Texting Ok? *
Parent/Guardian Info
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Phone *
Parent/Guardian Phone
Emergency Info
If none, please type none
Emergency Contact Person *
Emergency Contact Person
Emergency Contact Phone *
Emergency Contact Phone