2024 Summer Camp Registration  
Camp 1: June 3-5, Camp 2: June 7-9. BOTH camps are waitlist only for girls.  
Your registration will be confirmed when your $150 non refundable deposit is received. 
https://paypal.me/ArkansasVaultClub?locale.x=en_US to pay online or visit https://www.arkansasvaultclub.org/payments for more info.  
Deposits can also be paid in person or via mail.

Sign in to Google to save your progress. Learn more
Email *
Name of camper? *
Which camp dates?   BOTH camps are now waitlist only for girls.  *
Date of birth? (month/day/year) *
Gender? *
School & Current Grade? *
T shirt size?  (choose only 1) *
Required
Personal Record? *
Contact name and phone number? *
Camper insurance information? *
Do any of these apply? *
Required
If you checked any of the above, 'other' or camper has medication,  add any pertinent information.
Does the camper have specific dietary needs (vegetarian, lactose intolerant, etc)?  If yes, explain.
Any further information we need to know?
Parent/Guardian Authorization:  By signing my name below I attest the personal and medical information is correct and complete as far as I know. The person described has my permission to engage in all camp activities.  I give permission to the camp to provide routine health care, administer prescribed medications, and seek emergency medical treatment including ordering x-rays , routine tests, and treatment. I agree to the release of any records necessary for insurance purposes. I give permission to the camp to arrange necessary related transportation for me/my child.In the event that I cannot be reached in an emergency, I give permission to the physician selected by the camp to secure and administer treatment, including hospitalization for the person named above. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms