SMAC 2009 Registration

Parent's Name(S):

Camper's Name:

Last:
 Middle:
 First:

Sex:
Male
Female

Age:       Date of Birth:         Grade Completed:

T-Shirt Size:

Home Address:

City: State: Zip:

Country:

Phone:

Parent's E-Mail:

Camper's E-Mail:

If parent not available in emergency please contact:

Name: Phone:
Name: Phone:

Choose a Session(s):

Choose Native Language

Please rate your camper on the following activities

Backpacking:
Hiking:
Biking:
Swimming:
Canoeing:
Rafting:
Rock Climbing:
Rappelling:
Camping:
Kayaking:
Horseback Riding:

Please answer the following questions. Your answers will help us provide a positive camp experience for your child.

Is this your child's first overnight experience?

Does your child want to come to camp?

Does your child make new friends easily?

Is your child eager or hesitant to try new things?

Is your child likely to become homesick?

Are there ever problems with bedwetting, sleep walking, fear of dark, etc. with your child?

Are there any emotional/behavioral issues with your child that we should be aware of?

What do you hope your child will gain from this experience?

Any additional comments or information about your child that you want to share with us:

Intended Method of Payment: 

How did You Hear about us:

By placing a check in this box, I hereby give my permission for Smoky Mountain Adventure Camp to use any picture in which my child may appear in any of the camp literature as the camp chooses.