Youth Camp Registration
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A $75.00 non-refundable, non-transferrable deposit per camper must be made before an online registration will be processed. The $75.00 will be deducted from the camp fee.
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Deposit must be paid by June 1st in order to qualify for early registration.
You can either send a check to Camp Esquagama, 4913 Pine Lane, Gilbert, MN 55741 or if you would like to charge by Visa/MasterCard call 866-386-2267 |
Name
(Last, First, M.I.): |
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| Age: |
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| Sex: |
Female
Male
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| Birth Date: |
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| Parent or Guardian: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| County: |
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| Phone: |
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| *Email: |
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Period Selection (First Choice)
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Period Selection (Second Choice)
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| List one preferred cabin mate: |
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Note: One of our goals at Camp Esquagama is to encourage campers to make new friends. Please list only one cabin mate on the application. Groups of 4 or more will be divided into different cabins.
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| New Camper Referred: |
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Health Information |
| Parent or Guardian Name: |
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| Phone: |
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| Address: |
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Health History (Check affirmative)
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| Operations or serious injuries (dates): |
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| Chronic or recurring illness: |
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| Present Medications: |
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| Dietary Restrictions: |
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Specific activities restricted
(i.e. swimming, canoeing, water-skiing, etc.): |
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Please notify the camp if this camper is exposed to any communicable disease during the three weeks prior to camp attendance. If health history reveals problems, then a physical exam by a physician within one year is required.
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Immunization Record
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Parents' Authorization
By submitting this application, the parent agrees that the camper must conform to the rules and regulations of Camp Esquagama and agrees to cooperate with the staff in the best interests of Camp Esquagama and its campers. You understand that pictures of camp activities are taken routinely, and you give your permission to Camp Esquagama to use these pictures for promotional purposes. This application has your consent and approval. You further understand that the camp will not carry special health and accident insurance on your child.
Indicate your insurance company name and your policy number.
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| Insurance Company |
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| Policy Number |
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