Number of Attendees*Camper Name* First Last Parent Name* First Last List Additional Attendees Names here: Age of CamperDiagnosis of Camper* Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Dietary Needs and Allergies Anything Else We Should Know? Add it Here! I allow photos of my camper to be taken.* Yes No Photos can be used in marketing materials for Camp Korey. This includes print, social media and use on the Camp Korey website. NameThis field is for validation purposes and should be left unchanged.