*
Full Name:
M
F
Date of Birth
*
Email:
*
Current
Address:
*
Phone#:
(Where I can be reached now)
Cell Phone#:
Contact Time:
(Best to time to contact you)
Martial Status:
Married
Separated
Divorced
Single
Spouse's Name:
Children:
Occupation:
Employer :
Address:
Telephone:
Contact Person:
Position Desired:
Driver
Sport/Activity Specialist
Drama/Arts
Office/Clerical
Other
Nurse/EMT/Doctor
What are your main areas of interest:
Smoking Status:
Smoker
Non-Smoker
Availability:
I am available for all Camp Dates
Yes
No
(June 14, 2024 until August 10, 2024)
If NO, specify:
How did you hear about Wah-Nee?
Comments:
Days:
Hours:
Mins:
Secs:
