2010 Camp Stanley Camper Application

Camper's Name

Date of Birth (MO/DY/YEAR)

Present Grade BOY GIRL

Mailing Address


City


State


Zip


Home Phone Fax




Mother's Name
Home Address (if different)
Work Phone Cell Phone
Mother's Email




Father's Name
Home Address (if different)
Work Phone Cell Phone
Father's Email






Legal Guardian Name
Home Address (if different)
Work Phone Cell Phone
Legal Guardian's Email

Of three addresses above, camper lives primarily with:
Mother Father Legal Guardian


Siblings Names & Ages


I agree with all terms & conditions




August Address
1 Great Place
Smithfield, ME 04978
Winter Address
1 Huntington Ave. Suite 309
Boston, MA 02116








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