Alfred University Summer Application Form for Day Camps

Required fields (*)

Camp:

Living Situation:

*Has camper attended our camps before?

If yes, which camp?:

Basic Information:

*First Name:

*Last Name:

Camper's Mailing Address:

*Street:

*City:

*State:

*Zip Code:

*Country:

*Preferred First Name for Nametag:

*Gender:
Male Female

*T-shirt Size:

*Date of Birth (mm/dd/yyyy):
 

Age:

*Camper's Email Address:

Camper's High School Name (Sport Camps):

Camper's High School Graduation Year (Sport Camps):

AU Staff/Faculty Banner ID:
(AU Staff/Faculty will receive a discount when paying the final balance for academic camps.)
Please enter valid Banner ID to apply discount

Parents/Guardian's Name:

Mother's First Name:

Mother's Last Name:

Father's First Name:

Father's Last Name:

Guardian's First Name:

Guardian's Last Name:

Home Phone:
(ex. 607-123-1234)

Cell Phone:
(ex. 607-123-1234)

Work Phone:
(ex. 607-123-1234)

*Parent/Guardian Email:

Parent/Guardian Alt. Email:

Emergency Contact:

*First Name:

*Last Name:

*Relationship to Camper:

*Home Phone:
(ex. 607-123-1234 or enter N/A if none)

*Cell Phone:
(ex. 607-123-1234 or enter N/A if none)

*Work Phone:
(ex. 607-123-1234 or enter N/A if none)

*Emergency Email:

Payment Details:

Are Mailing and Billing address the same?
Yes No

*Account Holder's First Name:

*Account Holder's Last Name:

Middle Initial:

*Account Holder's Street:

*Account Holder's City:

*Account Holder's State:

*Account Holder's Zip Code:

*Please type what you see above: