2018 Camp Registration - Lotus Experience

Which session will you be attending?*
Camper's Name*
First Last
Age*
Date of Birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
School (Past Academic Year)*
Grade (Past Academic Year)*
Camper's Email
Parent/Guardian Name*
First Last
Parent/Guardian Email*
Parent/Guardian Phone*
Phone Type*
Parent Additional Phone
Second Parent Name
First Last
Second Parent Phone
Emergency Contact Name*
First Last
Relationship*
Emergency Contact Phone*
Medical Problems or Concerns
Medication Currently Taking
What are some things/areas you would like to change/grow/shift in your life? Why?*