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= Required Fields

Account Type

Select Account Type:

Primary Contact for account

Enter the information for the primary contact for this account. This person must be an adult.
First Name:

Last Name:

Middle Initial:
Nickname:
Gender:
Birth Date:

mm / dd / yyyy
Address:

City:

Country:
*
State / Province:
*
Zip / Postal Code:

Please give first and last name of camper(s) you would like to room with (limit 2):
Primary Phone
*



Alternate Phone:
Ext.



Alternate Phone 2:



E-mail Address:
*
Confirm E-mail Address:
*
Roles:
Please check all that apply










Additional Contact for account

Add an additional contact for this account by completing the information below.
This person is:
First Name:
Last Name:
Middle Initial:
Nickname:
Gender:
Birth Date:

mm / dd / yyyy
Address:
 
City:
Country:
State / Province:
Zip / Postal Code:
Please give first and last name of camper(s) you would like to room with (limit 2):
Primary Phone:


Alternate Phone:
Alternate Phone Ext:

Alternate Phone 2:

E-mail Address:
Confirm E-mail Address:

Roles:
Please check all that apply













Additional Information

Please provide the following information
How did you hear about us? Please check all that apply.











*

Login Information

The username and password must consist only of letters and/or numbers.  No special characters or spaces are allowed.
Username:
Password:
*
Confirm Password:
*
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2307 W. Maple Rapids Rd. • St. Johns • MI • 48879 • 833-588-2267
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